Cardiovascular Disease |

A Comparison of Bleeding Complications Between Warfarin, Dabigatran, and Rivaroxaban in Patients Undergoing Combined Cryo- and Radiofrequency Ablation FREE TO VIEW

Jordan Ray; David Snipelisky; Ryan Ung; Melissa Duart; Christine Kauffman; Fred Kusumoto
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Mayo Clinic, Jacksonville, FL

Chest. 2014;146(4_MeetingAbstracts):118A. doi:10.1378/chest.1993865
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SESSION TITLE: Arrhythmia Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: Warfarin has been widely used for anticoagulation in patients with atrial arrhythmias. However, recently, novel anticoagulants have become accepted alternatives. Combined cryo- and radiofrequency ablation is a newer approach to terminate atrial arrhythmias, which in general uses larger catheters and longer procedure times. No study has assessed bleeding complications in patients following this newer approach of combined cryo- and radiofrequency ablation for difficult to treat atrial arrhythmias. Our study compares bleeding risks between warfarin and two novel anticoagulants after a combined ablation approach.

METHODS: We combined all patients who underwent the hybrid cryo- and radiofrequency ablation for atrial fibrillation/flutter over the past 3 years. Patients were stratified into three subsets based on type of anticoagulation (warfarin, dabigatran, or rivaroxaban). Bleeding complications during the first 48 hours and during the first two weeks following the ablation were recorded. Comparisons were made using analysis of variance calculations. Major complications were defined as hemorrhage requiring blood products or need for vascular intervention. Minor complications included prolonged bleeding from catheter insertion site, development of ecchymosis, or hematoma formation.

RESULTS: Eighty-five patients met inclusion criteria of which 39 patients were on warfarin, 33 patients on dabigatran, and 13 patients on rivaroxaban. We found no difference in age, gender, or clinical characteristics between the three subsets. The overall bleeding complication rate was 14.1%. All complications occurred within the first 48 hours post-ablation. Six (15.4%) minor complications occurred in the warfarin subset, five (15.2%) in the rivaroxaban subset, and one (7.7%) in the dabigatran subset. No significant difference was noted in the warfarin, dabigatran, and rivaroxaban subsets in regard to overall bleeding complications (p=0.822).

CONCLUSIONS: Bleeding complications were similar between warfarin, dabigatran, and rivaroxaban post combined cryo- and radiofrequency ablation in our cohort. As well the overall complication rate in the combined approach is similar to previously published complication rates using only radiofrequency ablation.

CLINICAL IMPLICATIONS: Based on this study comparing bleeding risks, novel anticoagulants can be considered as alternatives to warfarin in those receiving combined cryo- and radiofrequency ablation.

DISCLOSURE: The following authors have nothing to disclose: Jordan Ray, David Snipelisky, Ryan Ung, Melissa Duart, Christine Kauffman, Fred Kusumoto

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