ABSTRACT
BACKGROUND: The real-world safety and efficacy of uninterrupted anticoagulation treatment with edoxaban (EDX) or warfarin (WFR) during the peri-procedural period of catheter ablation (CA) for atrial fibrillation (AF) are yet to be investigated. METHODS: We conducted a two-center experience, observational study to retrospectively investigate consecutive patients who underwent CA for AF and received EDX or WFR. We examined the incidence of thromboembolic and bleeding complications during the peri-procedural period. RESULTS: The EDX and WFR groups included 153 and 103 patients, respectively (total: 256 patients). Demise or thromboembolic events did not occur in either of the groups. The incidence of major bleeding in the EDX and WFR groups was 0.7% and 2.9%, respectively. The total incidence of major/minor bleeding in the EDX and WFR groups was 7.8% and 8.7%, respectively. Of note, the incidence of bleeding complications in the uninterrupted WFR strategy group was markedly high in patients with an estimated glomerular filtration rate (eGFR) <30 (75%) or a HAS-BLED score ≥3 (60%). Patients with eGFR ≥30 and a HAS-BLED score ≤2 had a lower incidence of bleeding (<10%), regardless of the administered anticoagulation drug (EDX or WFR). CONCLUSIONS: This study confirmed the safety and efficacy of uninterrupted anticoagulation therapy using EDX or WFR in real-world patients undergoing CA for AF. Patients with severely impaired renal function and/or a higher bleeding risk during uninterrupted therapy with WFR were at a prominent risk of bleeding. Therefore, particular attention should be paid in the treatment of these patients.
ABSTRACT
PURPOSE: To prospectively evaluate the frequency of fibers in the anterior chamber during and after cataract surgery, their source, and preventive measures. SETTING: Department of Ophthalmology, Setagaya-Shimoda Hospital, Tokyo, Japan. METHODS: Slitlamp biomicroscopy was used to examine 422 eyes after cataract surgery for frequency of fibers in the anterior chamber. In another 78 eyes having cataract surgery, fibers in the anterior chamber were removed and compared with fibrous materials used during surgery using microscopic and Raman spectrometric analyses. Dust-generation tests were conducted on the fibrous materials used in surgery. In 337 eyes having cataract surgery, highly dust-generating materials were excluded during surgery and the frequency of fibers in the anterior chamber was determined. RESULTS: After surgery, fibers were detected in the anterior chamber in 7 (1.7%) of 422 eyes. No inflammation was observed during a 1-year follow-up. During surgery, fibers suspended in the anterior chamber were observed in 5 (6.4%) of 78 eyes. Microscopic and Raman spectrometric analyses showed that the fibers were identical to the cotton fibers in cotton balls and gauze. Cotton balls had the highest dust-generation rate of fibrous materials used intraoperatively. Excluding cotton balls significantly reduced the frequency of fibers to 5 (1.5%) of 337 eyes (P = .0239). CONCLUSIONS: During routine cataract surgery, fibers were introduced into the anterior chamber in 6.4% of cases. Of the fibrous materials used in surgery, cotton balls generated the most fibers. Eliminating cotton balls alone significantly reduced the frequency of fibers in the anterior chamber to 1.5%.
