Document Detail


Prevention of Periprocedural Ischemic Stroke and Management of Hemorrhagic Complications in Atrial Fibrillation Ablation Under Continuous Warfarin Administration.
MedLine Citation:
PMID:  23350877     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
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 occu-rred with this approach, it was safely treated with PCC and vitamin K.
Authors:
Taishi Kuwahara; Atsushi Takahashi; Yoshihide Takahashi; Atushi Kobori; Shinsuke Miyazaki; Asumi Takei; Tadashi Fujino; Kenji Okubo; Katsumasa Takagi; Akira Fujii; Masateru Takigawa; Yuji Watari; Hiroyuki Hikita; Akira Sato; Kazutaka Aonuma
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-12-12
Journal Detail:
Title:  Journal of cardiovascular electrophysiology     Volume:  -     ISSN:  1540-8167     ISO Abbreviation:  J. Cardiovasc. Electrophysiol.     Publication Date:  2012 Dec 
Date Detail:
Created Date:  2013-1-28     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9010756     Medline TA:  J Cardiovasc Electrophysiol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
© 2013 Wiley Periodicals, Inc.
Affiliation:
Cardiovascular Center, Yokosuka Kyousai Hospital, Yokosuka, Kanagawa, Japan.
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