Real-world clinical practice of current periprocedural anticoagulation management in catheter ablation of atrial fibrillation: Data from a large prospective ablation registry

Background: The guidelines recommend anticoagulation management with uninterrupted warfarin or direct thrombin inhibitors (DTIs) during the atrial fibrillation (AF) ablation periprocedural period.

Objectives: To clarify the Japanese real-world latest periprocedural anticoagulation management during AF ablation.

Methods: This multicenter observational study included 6232 consecutive AF patients (68.7 ± 10.9 years, 4346 men) who underwent periprocedural anticoagulation therapy using direct oral anticoagulants (DOACs) between January 2022 and August 2023.

Results: The mean CHADS₂ and CHA₂DS₂VASc scores were 1.2 ± 1.1 and 2.3 ± 1.5. Bleeding and thromboembolic events occurred in 79 (1.3%) and eight (0.12%) patients. During the periprocedural period, factor Xa inhibitors (FXaIs) were used in 3063 patients (rivaroxaban in 624, apixaban in 1093, and edoxaban in 1345) and DTIs in 3170 including 2583 in whom DTIs were switched from FXaIs. Both the bleeding (0.85% vs. 1.69%, p = .003) and thromboembolic event rates (0.03% vs. 0.23%, p = .036) were significantly lower in the DTI- than FXaI-group. A multivariate analysis showed periprocedural FXaI use was significantly associated with both bleeding events (odds ratio [OR] = 1.92, 95% confidence interval [CI] = 1.20-3.08, p = .006) and cardiac tamponade (OR = 2.74, 95% CI = 1.27-5.9, p = .01). The interval between the last DOAC administration and the procedure was significantly shorter in the DTI- than FXaI-group (4.2 ± 4.9 vs. 19.3 ± 10.7 h, p < .01). In the FXaI-group, the bleeding rate tended to be lower in the minimally interrupted (n = 2105) than uninterrupted group (n = 821) (1.47% vs. 2.56%, p = .06). Two patients in the uninterrupted FXaI-group required surgical management for cardiac tamponade.

Conclusions: Our multicenter real-world data demonstrated that anticoagulation with DTIs was a reasonable periprocedural anticoagulation regimen to reduce periprocedural complications.