TY - JOUR
T1 - Periprocedural stroke and bleeding complications in patients undergoing catheter ablation of atrial fibrillation with different anticoagulation nagement results from the role of coumadin in preventing thromboembolism in atrial fibrillation (AF) patients undergoing catheter ablation (COMPARE) randomized trial
AU - Biase, Luigi Di
AU - Burkhardt, J. David
AU - Santangeli, Pasquale
AU - Mohanty, Prasant
AU - Sanchez, Javier E.
AU - Horton, Rodney
AU - Gallinghouse, G. Joseph
AU - Themistoclakis, Sakis
AU - Rossillo, Antonio
AU - Lakkireddy, Dhanunjaya
AU - Reddy, Madhu
AU - Hao, Steven
AU - Hongo, Richard
AU - Beheiry, Salwa
AU - Zagrodzky, Jason
AU - Rong, Bai
AU - Mohanty, Sanghamitra
AU - Elayi, Claude S.
AU - Forleo, Giovanni
AU - Pelargonio, Gemma
AU - Narducci, Maria Lucia
AU - Russo, Antonio Dello
AU - Casella, Michela
AU - Fassini, Gaetano
AU - Tondo, Claudio
AU - Schweikert, Robert A.
AU - Natale, Andrea
PY - 2014/6/24
Y1 - 2014/6/24
N2 - Background-Periprocedural thromboembolic and hemorrhagic events are worrisome complications of catheter ablation for atrial fibrillation (AF). The periprocedural anticoagulation management could play a role in the incidence of these complications. Although ablation procedures performed without warfarin discontinuation seem to be associated with lower thromboembolic risk, no randomized study exists. Methods and Results-This was a prospective, open-label, randomized, parallel-group, multicenter study assessing the role of continuous warfarin therapy in preventing periprocedural thromboembolic and hemorrhagic events after radiofrequency catheter ablation. Patients with CHADS2 score ?1 were included. Patients were randomly assigned in a 1:1 ratio to the offwarfarin or on-warfarin arm. The incidence of thromboembolic events in the 48 hours after ablation was the primary end point of the study. The study enrolled 1584 patients: 790 assigned to discontinue warfarin (group 1) and 794 assigned to continuous warfarin (group 2). No statistical difference in baseline characteristics was observed. There were 39 thromboembolic events (3.7% strokes [n=29] and 1.3% transient ischemic attacks [n=10]) in group 1: two events (0.87%) in patients with paroxysmal AF, 4 (2.3%) in patients with persistent AF, and 33 (8.5%) in patients with long-standing persistent AF. Only 2 strokes (0.25%) in patients with long-standing persistent AF were observed in group 2 (P<0.001). Warfarin discontinuation emerged as a strong predictor of periprocedural thromboembolism (odds ratio, 13; 95% confidence interval, 3.1-55.6; P<0.001). Conclusion-This is the first randomized study showing that performing catheter ablation of AF without warfarin discontinuation reduces the occurrence of periprocedural stroke and minor bleeding complications compared with bridging with low-molecular-weight heparin.
AB - Background-Periprocedural thromboembolic and hemorrhagic events are worrisome complications of catheter ablation for atrial fibrillation (AF). The periprocedural anticoagulation management could play a role in the incidence of these complications. Although ablation procedures performed without warfarin discontinuation seem to be associated with lower thromboembolic risk, no randomized study exists. Methods and Results-This was a prospective, open-label, randomized, parallel-group, multicenter study assessing the role of continuous warfarin therapy in preventing periprocedural thromboembolic and hemorrhagic events after radiofrequency catheter ablation. Patients with CHADS2 score ?1 were included. Patients were randomly assigned in a 1:1 ratio to the offwarfarin or on-warfarin arm. The incidence of thromboembolic events in the 48 hours after ablation was the primary end point of the study. The study enrolled 1584 patients: 790 assigned to discontinue warfarin (group 1) and 794 assigned to continuous warfarin (group 2). No statistical difference in baseline characteristics was observed. There were 39 thromboembolic events (3.7% strokes [n=29] and 1.3% transient ischemic attacks [n=10]) in group 1: two events (0.87%) in patients with paroxysmal AF, 4 (2.3%) in patients with persistent AF, and 33 (8.5%) in patients with long-standing persistent AF. Only 2 strokes (0.25%) in patients with long-standing persistent AF were observed in group 2 (P<0.001). Warfarin discontinuation emerged as a strong predictor of periprocedural thromboembolism (odds ratio, 13; 95% confidence interval, 3.1-55.6; P<0.001). Conclusion-This is the first randomized study showing that performing catheter ablation of AF without warfarin discontinuation reduces the occurrence of periprocedural stroke and minor bleeding complications compared with bridging with low-molecular-weight heparin.
KW - Atrial fibrillation
KW - Catheter ablation
KW - Catheter ablation radiofrequency
KW - Stroke
KW - Transient ischemic attack
KW - Warfarin
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U2 - 10.1161/CIRCULATIONAHA.113.006426
DO - 10.1161/CIRCULATIONAHA.113.006426
M3 - Article
C2 - 24744272
AN - SCOPUS:84903395277
SN - 0009-7322
VL - 129
SP - 2638
EP - 2644
JO - Circulation
JF - Circulation
IS - 25
ER -