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Prevention of Periprocedural Ischemic Stroke and Management of Hemorrhagic Complications in Atrial Fibrillation Ablation Under Continuous Warfarin Administration
Author(s) -
KUWAHARA TAISHI,
TAKAHASHI ATSUSHI,
TAKAHASHI YOSHIHIDE,
KOBORI ATUSHI,
MIYAZAKI SHINSUKE,
TAKEI ASUMI,
FUJINO TADASHI,
OKUBO KENJI,
TAKAGI KATSUMASA,
FUJII AKIRA,
TAKIGAWA MASATERU,
WATARI YUJI,
HIKITA HIROYUKI,
SATO AKIRA,
AONUMA KAZUTAKA
Publication year - 2013
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/jce.12069
Subject(s) - medicine , warfarin , atrial fibrillation , tamponade , cardiac tamponade , anesthesia , stroke (engine) , catheter ablation , cardiology , surgery , mechanical engineering , engineering
Atrial Fibrillation Ablation on Warfarin Introduction This study aimed to determine the effects of continuing warfarin administration during the periprocedural period of catheter ablation for atrial fibrillation (AF) on the prevention of stroke complications and to evaluate the management of hemorrhagic complications occurring with this approach. Methods and Results A total of 3,280 patients undergoing AF catheter ablation at our institution were divided into 2 groups: the first 1,953 patients who discontinued warfarin 3–4 days before AF ablation and were bridged with heparin (warfarin‐discontinued group), and the last 1,327 patients who continued warfarin throughout the periprocedural period (warfarin‐continued group). Symptomatic stroke or transient ischemic attack occurred in 13/1,953 patients (0.67%) in the warfarin‐discontinued group and in 2/1,327 patients (0.15%) in the warfarin‐continued group (P = 0.021). None of the patients with therapeutic international normalized ratio at the time of the procedure had periprocedural thromboembolism in the warfarin‐continued group. Major hemorrhagic complications occurred in 26/1,953 patients in the warfarin‐discontinued group (1.3%; 25 with cardiac tamponade and 1 with retroperitoneal bleeding), and in 15/1,327 patients in the warfarin‐continued group (1.1%; 14 with cardiac tamponade and 1 with abdominal wall bleeding) (P = 0.80). Of the 14 warfarin‐continued patients with cardiac tamponade, 13 were administered prothrombin complex concentrate (PCC) and vitamin K; the bleeding was stopped safely without surgical repair. Conclusion The continuation of warfarin during the periprocedural period of AF ablation could reduce the incidence of stroke without increasing hemorrhagic complications. When cardiac tamponade occurred with this approach, it was safely treated with PCC and vitamin K.