Author + information
- Received May 16, 2019
- Revision received August 30, 2019
- Accepted September 4, 2019
- Published online October 30, 2019.
- Satoshi Yanagisawa, MD, PhDa,∗ (, )
- Yasuya Inden, MD, PhDb,
- Aya Fujii, MDb,
- Yusuke Sakamoto, MDb,
- Toshiro Tomomatsu, MDb,
- Keita Mamiya, MDb,
- Hiroya Okamoto, MDb,
- Rei Shibata, MD, PhDa and
- Toyoaki Murohara, MD, PhDb
- aDepartment of Advanced Cardiovascular Therapeutics, Nagoya University Graduate School of Medicine, Nagoya, Japan
- bDepartment of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
- ↵∗Address for correspondence:
Dr. Satoshi Yanagisawa, Department of Advanced Cardiovascular Therapeutics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan.
Objective The aim of this study was to evaluate the extent of changes in prothrombotic responses after catheter ablation for atrial fibrillation (AF) under uninterrupted oral anticoagulant agent (OAC) administration.
Background Catheter ablation for AF has a potential risk for prothrombotic activation and silent thromboembolic events.
Methods A total of 814 patients (n = 172 [warfarin], n = 153 [dabigatran], n = 134 [rivaroxaban], and n = 301 [apixaban] patients undergoing AF ablation and a control group of 54 patients undergoing non-AF ablation) were included. Uninterrupted OACs were administered during the procedure in patients with AF. Blood samples were collected the day before and 3 days after the procedure.
Results At baseline, d-dimer levels were within normal limits (≤1.0 μg/ml) in more than 90% of the patients in all groups. However, after 3 days, this proportion decreased to 67%, 73%, 59%, 68%, and 65% in the warfarin, dabigatran, rivaroxaban, apixaban, and control groups, respectively (p = 0.180). Changes in prothrombin fragment 1+2 levels differed (p < 0.001), whereas fibrin monomer complex levels 3 days after ablation at a trough were equivalent within normal ranges among the groups (p = 0.146). Multivariate analysis revealed that age, CHA2DS2-VASc score, first session, and radiofrequency ablation were independent predictors of increased d-dimer levels after the procedure. Various changes in prothrombotic markers were observed between the warfarin and direct OAC groups after propensity score matching analyses.
Conclusions The coagulation cascade was activated after catheter ablation for AF under uninterrupted OAC administration. The changes in various prothrombotic markers differed among the OAC groups.
Dr. Yanagisawa and Dr. Shibata are affiliated with a department sponsored by Medtronic Japan. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received May 16, 2019.
- Revision received August 30, 2019.
- Accepted September 4, 2019.
- 2019 American College of Cardiology Foundation
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