Preprocedural therapeutic international normalized ratio influence on bleeding complications in atrial fibrillation ablation with continued anticoagulation with warfarin

Circ J. 2013;77(2):338-44. doi: 10.1253/circj.cj-12-0743. Epub 2012 Oct 20.

Abstract

Background: Safety of atrial fibrillation (AF) ablation in conditions of periprocedural therapeutic international normalized ratio (INR) in combination with heparin is still uncertain, and little is known about the pre-procedural therapeutic INR influence on bleeding complications (BC) in this method.

Methods and results: The subjects were 150 consecutive patients who underwent catheter ablation for AF with therapeutic INR. The patients were classified into 2 groups, BC (Group BC) and no BC (Group No BC), by whether they did or did not have BC, respectively. Differences in various parameters, including pre- and post-procedural prothrombin time-INR and activated partial thromboplastin time (APTT), were compared between the 2 groups. None of the patients experienced stroke or transient ischemic attack. In the 22 patients (15%) who had BC (Group BC), 3 patients had major and 19 patients had minor BC. There were no significant differences between the 2 groups in pre-procedural INR, APTT, and amount of heparin administered during the procedure. However, post-procedural INR and APTT were significantly prolonged in Group BC (2.5 ± 0.5 vs. 2.2 ± 0.5, P=0.016, 65 ± 45 vs. 44 ± 11, P<0.0001 respectively). Multivariable analysis showed that post-procedural APTT was the only independent bleeding risk factor (P=0.022).

Conclusions: AF ablation with peri-procedural therapeutic INR in combination with heparin seems to be safe. Presence or absence of BC are not related to the pre-procedural INR level, but to post-procedural APTT.

MeSH terms

  • Adult
  • Aged
  • Anticoagulants / administration & dosage
  • Anticoagulants / adverse effects
  • Atrial Fibrillation / drug therapy
  • Atrial Fibrillation / surgery*
  • Catheter Ablation / adverse effects*
  • Catheter Ablation / statistics & numerical data
  • Drug Monitoring / methods
  • Female
  • Fibrin Fibrinogen Degradation Products / metabolism
  • Follow-Up Studies
  • Hemorrhage / blood*
  • Hemorrhage / chemically induced
  • Hemorrhage / epidemiology
  • Heparin / administration & dosage
  • Heparin / adverse effects
  • Heparin Antagonists / administration & dosage
  • Humans
  • International Normalized Ratio*
  • Intraoperative Complications / blood
  • Intraoperative Complications / chemically induced
  • Intraoperative Complications / epidemiology
  • Male
  • Middle Aged
  • Partial Thromboplastin Time
  • Protamines / administration & dosage
  • Retrospective Studies
  • Risk Factors
  • Sex Distribution
  • Stroke / epidemiology
  • Stroke / prevention & control
  • Thromboembolism / epidemiology
  • Thromboembolism / prevention & control*
  • Warfarin / administration & dosage*
  • Warfarin / adverse effects

Substances

  • Anticoagulants
  • Fibrin Fibrinogen Degradation Products
  • Heparin Antagonists
  • Protamines
  • fibrin fragment D
  • Warfarin
  • Heparin