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Apixaban versus Warfarin for the Prevention of Periprocedural Cerebral Thromboembolism in Atrial Fibrillation Ablation: Multicenter Prospective Randomized Study
Author(s) -
KUWAHARA TAISHI,
ABE MITSUNORI,
YAMAKI MASARU,
FUJIEDA HIROYUKI,
ABE YUMIKO,
HASHIMOTO KATSUSHI,
ISHIBA MISAKO,
SAKAI HIROTSUKA,
HISHIKARI KEIICHI,
TAKIGAWA MASATERU,
OKUBO KENJI,
TAKAGI KATSUMASA,
TANAKA YASUAKI,
NAKAJIMA JUN,
TAKAHASHI ATSUSHI
Publication year - 2016
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.12928
Subject(s) - apixaban , medicine , warfarin , atrial fibrillation , stroke (engine) , cardiology , catheter ablation , prospective cohort study , anesthesia , surgery , rivaroxaban , mechanical engineering , engineering
Apixaban Thromboembolism Prevention in AF Ablation Introduction Stroke can be a life‐threatening complication of atrial fibrillation (AF) catheter ablation. Uninterrupted warfarin treatment contributes to minimizing the risk of stroke complications. Methods and Results This was a prospective, open‐label, randomized, multicenter study assessing the safety and efficacy of apixaban for the prevention of cerebral thromboembolism complicating AF catheter ablation. Two hundred patients with drug‐resistant AF were equally assigned to take either apixaban (5 mg or 2.5 mg twice daily) or warfarin (target international normalized ratio, 2‐3) for at least 1 month before AF ablation. Neither drug regimen was interrupted throughout the operative period. Diffusion‐weighted magnetic resonance imaging was performed for all patients to detect silent cerebral infarction (SCI) after the ablation. Primary outcomes were defined as the occurrence of stroke, transient ischemic attack, SCI, or major bleeding that required intervention. The secondary outcome was minor bleeding. The groups did not statistically differ in patients’ backgrounds or procedural parameters. During AF ablation, the apixaban group required administration of more heparin to maintain an activated clotting time > 300 seconds than the warfarin group (apixaban, 14,000 ± 4,000 units; warfarin, 9,000 ± 3,000 units). Three primary outcome events occurred in each group (apixaban, 2 SCI and 1 major bleed; warfarin, 3 SCI, P = 1.00), and 3 and 4 secondary outcome events occurred in the apixaban and warfarin groups (P = 0.70), respectively. Conclusion Apixaban has similar safety and effectiveness to warfarin for the prevention of cerebral thromboembolism during the periprocedural period of AF ablation.