Prevention of Periprocedural Ischemic Stroke and Management of Hemorrhagic Complications in Atrial Fibrillation Ablation Under Continuous Warfarin Administration
Article first published online: 25 JAN 2013
© 2012 Wiley Periodicals, Inc.
Journal of Cardiovascular Electrophysiology
Volume 24, Issue 5, pages 510–515, May 2013
How to Cite
KUWAHARA, T., TAKAHASHI, A., TAKAHASHI, Y., KOBORI, A., MIYAZAKI, S., TAKEI, A., FUJINO, T., OKUBO, K., TAKAGI, K., FUJII, A., TAKIGAWA, M., WATARI, Y., HIKITA, H., SATO, A. and AONUMA, K. (2013), Prevention of Periprocedural Ischemic Stroke and Management of Hemorrhagic Complications in Atrial Fibrillation Ablation Under Continuous Warfarin Administration. Journal of Cardiovascular Electrophysiology, 24: 510–515. doi: 10.1111/jce.12069
- Issue published online: 26 APR 2013
- Article first published online: 25 JAN 2013
- Accepted manuscript online: 12 DEC 2012 06:50AM EST
- Manuscript Accepted: 30 NOV 2012
- Manuscript Revised: 27 NOV 2012
- Manuscript Received: 2 OCT 2012
- atrial fibrillation;
- catheter ablation;
- pulmonary vein isolation;
Atrial Fibrillation Ablation on Warfarin
This study aimed to determine the effects of continuing warfarin administration during the periprocedural period of catheter ablation for atrial fibrillation (AF) on the prevention of stroke complications and to evaluate the management of hemorrhagic complications occurring with this approach.
Methods and Results
A total of 3,280 patients undergoing AF catheter ablation at our institution were divided into 2 groups: the first 1,953 patients who discontinued warfarin 3–4 days before AF ablation and were bridged with heparin (warfarin-discontinued group), and the last 1,327 patients who continued warfarin throughout the periprocedural period (warfarin-continued group). Symptomatic stroke or transient ischemic attack occurred in 13/1,953 patients (0.67%) in the warfarin-discontinued group and in 2/1,327 patients (0.15%) in the warfarin-continued group (P = 0.021). None of the patients with therapeutic international normalized ratio at the time of the procedure had periprocedural thromboembolism in the warfarin-continued group. Major hemorrhagic complications occurred in 26/1,953 patients in the warfarin-discontinued group (1.3%; 25 with cardiac tamponade and 1 with retroperitoneal bleeding), and in 15/1,327 patients in the warfarin-continued group (1.1%; 14 with cardiac tamponade and 1 with abdominal wall bleeding) (P = 0.80). Of the 14 warfarin-continued patients with cardiac tamponade, 13 were administered prothrombin complex concentrate (PCC) and vitamin K; the bleeding was stopped safely without surgical repair.
The continuation of warfarin during the periprocedural period of AF ablation could reduce the incidence of stroke without increasing hemorrhagic complications. When cardiac tamponade occurred with this approach, it was safely treated with PCC and vitamin K.