Bleeding, Thromboembolic Events With Apixaban Interruption During Afib Ablation
Only 11.3% of patients on uninterrupted apixaban and 9.7% of patients on interrupted apixaban experienced clinically significant bleed.
HealthDay News — For patients undergoing catheter ablation for nonvalvular atrial fibrillation (AF), both uninterrupted and minimally interrupted apixaban are associated with a very low rate of thromboembolic events, according to a study published JACC: Clinical Electrophysiology.
Matthew R. Reynolds, MD, from Lahey Hospital & Medical Center in Burlington, Masschusetts, and colleagues randomized 300 patients undergoing catheter ablation for nonvalvular AF to uninterrupted or minimally interrupted peri-procedural apixaban. For comparison, a retrospective cohort of patients treated with uninterrupted warfarin at the same centers was matched to the apixaban-treated subjects.
The researchers identified no stroke/systemic embolism events.
Overall, 11.3% of the 150 evaluable patients on uninterrupted apixaban and 9.7% of 145 evaluable patients on interrupted apixaban had clinically significant bleeding (risk difference, 1.7%; 95% CI, −5.5 to 8.8%; P = NS). The rates of major bleeding were 1.3% and 2.1% in the uninterrupted apixaban and interrupted apixaban groups, respectively (risk difference, −0.7%; P = NS). For all apixaban patients combined, the rates of clinically significant and major bleeding were similar (10.5% and 1.7%, respectively) to those of the matched warfarin group (9.8% and 1.4%, respectively).
"Both uninterrupted and minimally interrupted apixaban at the time of AF ablation were associated with a very low rate of thromboembolic events, and rates of both major (<2%) and clinically significant bleeding, which were similar to uninterrupted warfarin," the authors write.
Several authors disclosed financial ties to the pharmaceutical and medical device industries.
Reynolds MR, Allison JS, Natale A, et al. A prospective randomized trial of apixaban dosing during atrial fibrillation ablation [published online December 2017]. JACC: Clin Electrophysiol. doi: 10.1016/j.jacep.2017.11.005