Safety of ablation for atrial fibrillation with therapeutic INR: comparison with transition to low-molecular-weight heparin.
| Autor: | Saad EB; Centro de Fibrilação Atrial, Setor de Arritmia Invasiva, Hospital Pró-Cardíaco, Rio de Janeiro, Brazil. eduardobsaad@hotmail.com, Costa IP, Costa RE, Inácio LA Jr, Slater C, Camiletti A, Moura Neto DG, Maldonado P, Camanho LE, Polanczky CA |
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| Jazyk: | English; Portuguese |
| Zdroj: | Arquivos brasileiros de cardiologia [Arq Bras Cardiol] 2011 Oct; Vol. 97 (4), pp. 289-96. Date of Electronic Publication: 2011 Aug 19. |
| DOI: | 10.1590/s0066-782x2011005000088 |
| Abstrakt: | Background: The ideal management of oral anticoagulation (OAC) before and after catheter ablation for atrial fibrillation (AF) is still controversial. Objective: To compare two anticoagulation strategies for catheter ablation for AF: warfarin withholding and use of low-molecular-weight heparin (LMWH); and maintenance of warfarin and therapeutic INR (between 2.0 and 3.0). Methods: 140 patients (pt) with persistent/permanent AF undergoing catheter ablation for AF were divided into two groups: Group I (70 pt), in which warfarin was withheld five days prior to the procedure and transition to LMWH was used (enoxaparin: 1 mg/kg 2x/day before ablation, and 0.5 mg/kg 2x/day after ablation); Group II (70 pt), in which warfarin was not withheld and the procedure was performed with therapeutic INR. Both groups received intravenous heparin (ACT > 350 seconds) during ablation. Results: In Group I, one pt (1.4%) had a major hemorrhagic complication and four pts (5.7%) had minor hemorrhagic complications. In Group II, two pts (2.8%) had minor hemorrhagic complications and one pt had a major bleeding, which occurred after using LMWH due to INR < 2.0. None of the groups had thromboembolic complications or cardiovascular death over a period of 16 ± 8 months. Conclusion: Catheter ablation for AF without withholding OAC and with therapeutic INR is a strategy that has similar safety and efficacy when compared with the traditional transition to LMWH, avoiding the potentially inadequate anticoagulation of the initial post-ablation period. |
| Databáze: | MEDLINE |
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