3 years ago

Renal function and risk of stroke and bleeding in patients undergoing catheter ablation for atrial fibrillation: comparison between uninterrupted direct oral anticoagulants and warfarin administration

The effect of uninterrupted oral anticoagulant use in patients with chronic kidney disease (CKD) during catheter ablation for atrial fibrillation (AF) is not fully understood. Objective The present study aimed to evaluate safety and efficacy of periprocedural uninterrupted direct oral anticoagulant (DOAC) use compared with uninterrupted warfarin in patients undergoing catheter ablation for AF, stratified by various renal function groups. Methods A total of 2,091 patients were retrospectively included. The study population was divided into 4 groups: creatinine clearance (CrCl) ≥80 mL/min (n = 1,086), 50-79 mL/min (n = 774), 15-49 mL/min (n = 209), and <15 mL/min (n = 22). We investigated periprocedural complications and compared them between uninterrupted DOAC and warfarin groups. Results There was no significant difference in thromboembolic events among the 4 groups (0.6%, 0.6%, 1.0%, and 0%, respectively; p = 0.792). However, major bleeding events (0.9%, 1.4%, 4.8%, and 4.5%; p < 0.001) and minor bleeding events (4.1%, 6.1%, 11.5%, and 13.6%; p < 0.001) primarily occurred in patients with CKD. The rate of periprocedural complications in the DOAC group was similar to that in the warfarin group for each renal function category. Adverse events did not differ after adjustment using propensity score-matched analysis. Multivariate analysis showed that lower body weight, antiplatelet drug use, initial ablation session, and CKD were independent predictors of adverse events. Conclusion The periprocedural bleeding risk was increased in patients with CKD. Uninterrupted DOAC and warfarin administration during catheter ablation for AF in patients with CKD is feasible and effective.

Publisher URL: www.sciencedirect.com/science

DOI: S154752711731247X

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