Clinical experience of uninterrupted oral anticoagulants during atrial fibrillation ablation in elderly patients: a comp
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ORIGINAL ARTICLE
Clinical experience of uninterrupted oral anticoagulants during atrial fibrillation ablation in elderly patients: a comparison with non‑elderly patients Yasuharu Matsunaga‑Lee1 · Yasuyuki Egami1 · Kyosuke Yanagawa1 · Hitoshi Nakamura1 · Yutaka Matsuhiro1 · Koji Yasumoto1 · Masaki Tsuda1 · Naotaka Okamoto1 · Akihiro Tanaka1 · Masamichi Yano1 · Masaki Yamato1 · Ryu Shutta1 · Yasushi Sakata2 · Masami Nishino1 · Jun Tanouchi1 Received: 23 January 2020 / Accepted: 17 April 2020 © Springer Japan KK, part of Springer Nature 2020
Abstract It is unclear whether uninterrupted oral anticoagulants (OACs) are acceptable in elderly patients as compared to non-elderly patients. This study aimed to assess the clinical impact of an uninterrupted OAC strategy during atrial fibrillation (AF) ablation in elderly patients. We enrolled 439 consecutive patients who underwent AF ablation with an uninterrupted OAC strategy at our institute. The incidence of bleeding and thromboembolic complications during the AF ablation or within 4 weeks after and the anticoagulation status during the AF ablation were compared between the elderly (age ≧ 75, n = 144) and non-elderly groups (n = 295). There were 22 bleeding complications in the elderly group and 31 in the non-elderly group (15% vs. 11%, p = 0.162) and 3 major bleeding complications in the elderly group and 2 in the non-elderly group (2% vs. 0.7%, p = 0.336). Thromboembolic events were observed in 1 patient in the elderly group and 2 in the non-elderly group (0.7% vs. 0.7%, p = 1.000). The ACT at the end of the procedure was longer in the elderly group than in the non-elderly group (350 s vs. 341 s, p = 0.007) and the proportion of a prolonged ACT of > 400 s (27% vs. 18%, p = 0.046) was more frequent in the elderly group than non-elderly group. A propensity score matched population excluding the age and body weight, revealed that the anticoagulation status during AF ablation was comparable between the two groups. Thus, in the patients undergoing AF ablation with uninterrupted OAC strategy, bleeding complications in elderly patients were similar to those in non-elderly patients. The anticoagulation status during the procedure in elderly patients was more prolonged than that in non-elderly patients. Keywords Atrial fibrillation · Ablation · Elderly · Oral anticoagulation
Introduction Catheter ablation of atrial fibrillation (AF) has been widely accepted as a therapeutic option for AF in the recent era. The procedure requires peri-procedural anticoagulation with intravenous anticoagulation and oral anticoagulants (OACs). Several recent reports have demonstrated the efficacy and safety of an uninterrupted oral anticoagulant strategy of a * Masami Nishino [email protected] 1
Division of Cardiology, Osaka Rosai Hospital, 3‑1179 Nagasonecho, kita‑ku, Sakai, Osaka, Japan
Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
2
vitamin K antagonist (VKA) or direct oral anticoagulants (DOACs) during AF ablation [1–5].
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