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Periprocedural stroke and bleeding complications in patients undergoing catheter ablation of atrial fibrillation with different anticoagulation management: results from the Role of Coumadin in Preventing Thromboembolism in Atrial Fibrillation (AF) Patients Undergoing Catheter Ablation (COMPARE) randomized trial.
Di Biase, Luigi; Burkhardt, J David; Santangeli, Pasquale; Mohanty, Prasant; Sanchez, Javier E; Horton, Rodney; Gallinghouse, G Joseph; Themistoclakis, Sakis; Rossillo, Antonio; Lakkireddy, Dhanunjaya; Reddy, Madhu; Hao, Steven; Hongo, Richard; Beheiry, Salwa; Zagrodzky, Jason; Rong, Bai; Mohanty, Sanghamitra; Elayi, Claude S; Forleo, Giovanni; Pelargonio, Gemma; Narducci, Maria Lucia; Dello Russo, Antonio; Casella, Michela; Fassini, Gaetano; Tondo, Claudio; Schweikert, Robert A; Natale, Andrea.
Afiliação
  • Di Biase L; From the Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin (L.D.B., J.D.B., P.S., P.M., J.E.S., R. Horton, G.J.G., J.Z., B.R., S.M., A.N.); Albert Einstein College of Medicine, Montefiore Hospital, New York, NY (L.D.B.); Department of Biomedical Engineering, University of Texas,
  • Burkhardt JD; From the Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin (L.D.B., J.D.B., P.S., P.M., J.E.S., R. Horton, G.J.G., J.Z., B.R., S.M., A.N.); Albert Einstein College of Medicine, Montefiore Hospital, New York, NY (L.D.B.); Department of Biomedical Engineering, University of Texas,
  • Santangeli P; From the Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin (L.D.B., J.D.B., P.S., P.M., J.E.S., R. Horton, G.J.G., J.Z., B.R., S.M., A.N.); Albert Einstein College of Medicine, Montefiore Hospital, New York, NY (L.D.B.); Department of Biomedical Engineering, University of Texas,
  • Mohanty P; From the Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin (L.D.B., J.D.B., P.S., P.M., J.E.S., R. Horton, G.J.G., J.Z., B.R., S.M., A.N.); Albert Einstein College of Medicine, Montefiore Hospital, New York, NY (L.D.B.); Department of Biomedical Engineering, University of Texas,
  • Sanchez JE; From the Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin (L.D.B., J.D.B., P.S., P.M., J.E.S., R. Horton, G.J.G., J.Z., B.R., S.M., A.N.); Albert Einstein College of Medicine, Montefiore Hospital, New York, NY (L.D.B.); Department of Biomedical Engineering, University of Texas,
  • Horton R; From the Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin (L.D.B., J.D.B., P.S., P.M., J.E.S., R. Horton, G.J.G., J.Z., B.R., S.M., A.N.); Albert Einstein College of Medicine, Montefiore Hospital, New York, NY (L.D.B.); Department of Biomedical Engineering, University of Texas,
  • Gallinghouse GJ; From the Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin (L.D.B., J.D.B., P.S., P.M., J.E.S., R. Horton, G.J.G., J.Z., B.R., S.M., A.N.); Albert Einstein College of Medicine, Montefiore Hospital, New York, NY (L.D.B.); Department of Biomedical Engineering, University of Texas,
  • Themistoclakis S; From the Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin (L.D.B., J.D.B., P.S., P.M., J.E.S., R. Horton, G.J.G., J.Z., B.R., S.M., A.N.); Albert Einstein College of Medicine, Montefiore Hospital, New York, NY (L.D.B.); Department of Biomedical Engineering, University of Texas,
  • Rossillo A; From the Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin (L.D.B., J.D.B., P.S., P.M., J.E.S., R. Horton, G.J.G., J.Z., B.R., S.M., A.N.); Albert Einstein College of Medicine, Montefiore Hospital, New York, NY (L.D.B.); Department of Biomedical Engineering, University of Texas,
  • Lakkireddy D; From the Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin (L.D.B., J.D.B., P.S., P.M., J.E.S., R. Horton, G.J.G., J.Z., B.R., S.M., A.N.); Albert Einstein College of Medicine, Montefiore Hospital, New York, NY (L.D.B.); Department of Biomedical Engineering, University of Texas,
  • Reddy M; From the Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin (L.D.B., J.D.B., P.S., P.M., J.E.S., R. Horton, G.J.G., J.Z., B.R., S.M., A.N.); Albert Einstein College of Medicine, Montefiore Hospital, New York, NY (L.D.B.); Department of Biomedical Engineering, University of Texas,
  • Hao S; From the Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin (L.D.B., J.D.B., P.S., P.M., J.E.S., R. Horton, G.J.G., J.Z., B.R., S.M., A.N.); Albert Einstein College of Medicine, Montefiore Hospital, New York, NY (L.D.B.); Department of Biomedical Engineering, University of Texas,
  • Hongo R; From the Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin (L.D.B., J.D.B., P.S., P.M., J.E.S., R. Horton, G.J.G., J.Z., B.R., S.M., A.N.); Albert Einstein College of Medicine, Montefiore Hospital, New York, NY (L.D.B.); Department of Biomedical Engineering, University of Texas,
  • Beheiry S; From the Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin (L.D.B., J.D.B., P.S., P.M., J.E.S., R. Horton, G.J.G., J.Z., B.R., S.M., A.N.); Albert Einstein College of Medicine, Montefiore Hospital, New York, NY (L.D.B.); Department of Biomedical Engineering, University of Texas,
  • Zagrodzky J; From the Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin (L.D.B., J.D.B., P.S., P.M., J.E.S., R. Horton, G.J.G., J.Z., B.R., S.M., A.N.); Albert Einstein College of Medicine, Montefiore Hospital, New York, NY (L.D.B.); Department of Biomedical Engineering, University of Texas,
  • Rong B; From the Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin (L.D.B., J.D.B., P.S., P.M., J.E.S., R. Horton, G.J.G., J.Z., B.R., S.M., A.N.); Albert Einstein College of Medicine, Montefiore Hospital, New York, NY (L.D.B.); Department of Biomedical Engineering, University of Texas,
  • Mohanty S; From the Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin (L.D.B., J.D.B., P.S., P.M., J.E.S., R. Horton, G.J.G., J.Z., B.R., S.M., A.N.); Albert Einstein College of Medicine, Montefiore Hospital, New York, NY (L.D.B.); Department of Biomedical Engineering, University of Texas,
  • Elayi CS; From the Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin (L.D.B., J.D.B., P.S., P.M., J.E.S., R. Horton, G.J.G., J.Z., B.R., S.M., A.N.); Albert Einstein College of Medicine, Montefiore Hospital, New York, NY (L.D.B.); Department of Biomedical Engineering, University of Texas,
  • Forleo G; From the Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin (L.D.B., J.D.B., P.S., P.M., J.E.S., R. Horton, G.J.G., J.Z., B.R., S.M., A.N.); Albert Einstein College of Medicine, Montefiore Hospital, New York, NY (L.D.B.); Department of Biomedical Engineering, University of Texas,
  • Pelargonio G; From the Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin (L.D.B., J.D.B., P.S., P.M., J.E.S., R. Horton, G.J.G., J.Z., B.R., S.M., A.N.); Albert Einstein College of Medicine, Montefiore Hospital, New York, NY (L.D.B.); Department of Biomedical Engineering, University of Texas,
  • Narducci ML; From the Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin (L.D.B., J.D.B., P.S., P.M., J.E.S., R. Horton, G.J.G., J.Z., B.R., S.M., A.N.); Albert Einstein College of Medicine, Montefiore Hospital, New York, NY (L.D.B.); Department of Biomedical Engineering, University of Texas,
  • Dello Russo A; From the Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin (L.D.B., J.D.B., P.S., P.M., J.E.S., R. Horton, G.J.G., J.Z., B.R., S.M., A.N.); Albert Einstein College of Medicine, Montefiore Hospital, New York, NY (L.D.B.); Department of Biomedical Engineering, University of Texas,
  • Casella M; From the Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin (L.D.B., J.D.B., P.S., P.M., J.E.S., R. Horton, G.J.G., J.Z., B.R., S.M., A.N.); Albert Einstein College of Medicine, Montefiore Hospital, New York, NY (L.D.B.); Department of Biomedical Engineering, University of Texas,
  • Fassini G; From the Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin (L.D.B., J.D.B., P.S., P.M., J.E.S., R. Horton, G.J.G., J.Z., B.R., S.M., A.N.); Albert Einstein College of Medicine, Montefiore Hospital, New York, NY (L.D.B.); Department of Biomedical Engineering, University of Texas,
  • Tondo C; From the Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin (L.D.B., J.D.B., P.S., P.M., J.E.S., R. Horton, G.J.G., J.Z., B.R., S.M., A.N.); Albert Einstein College of Medicine, Montefiore Hospital, New York, NY (L.D.B.); Department of Biomedical Engineering, University of Texas,
  • Schweikert RA; From the Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin (L.D.B., J.D.B., P.S., P.M., J.E.S., R. Horton, G.J.G., J.Z., B.R., S.M., A.N.); Albert Einstein College of Medicine, Montefiore Hospital, New York, NY (L.D.B.); Department of Biomedical Engineering, University of Texas,
  • Natale A; From the Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin (L.D.B., J.D.B., P.S., P.M., J.E.S., R. Horton, G.J.G., J.Z., B.R., S.M., A.N.); Albert Einstein College of Medicine, Montefiore Hospital, New York, NY (L.D.B.); Department of Biomedical Engineering, University of Texas,
Circulation ; 129(25): 2638-44, 2014 Jun 24.
Article em En | MEDLINE | ID: mdl-24744272
ABSTRACT

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 11 ratio to the off-warfarin 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. CLINICAL TRIAL REGISTRATION URL http//www.clinicaltrials.gov. Unique identifier NCT01006876.
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Fibrilação Atrial / Tromboembolia / Varfarina / Ablação por Cateter / Acidente Vascular Cerebral / Hemorragia / Anticoagulantes Idioma: En Ano de publicação: 2014 Tipo de documento: Article
Texto completo
Imprimir
XML
PubMed Links
Buscar no Google

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Fibrilação Atrial / Tromboembolia / Varfarina / Ablação por Cateter / Acidente Vascular Cerebral / Hemorragia / Anticoagulantes Idioma: En Ano de publicação: 2014 Tipo de documento: Article