Intraprocedural anticoagulation and postprocedural hemoglobin fall in
atrial fibrillation ablation with minimally interrupted direct oral
anticoagulants: comparisons across 4 drugs
Abstract
Background: Thromboembolic or hemorrhagic complications related to
atrial fibrillation (AF) ablation are rare, and thus, it is difficult to
compare their frequency across different direct oral anticoagulants
(DOACs). We aimed to compare the intraablation blood coagulability and
postprocedural hemoglobin fall as alternatives to those complications
across 4 DOACs. Methods: We enrolled AF patients younger than 65 years
old in 3 cardiovascular centers who skipped a single dose of apixaban,
dabigatran, edoxaban, and rivaroxaban, prior to the ablation. Endpoints
included the activated clotting time (ACT), heparin requirement during
the ablation, and drop in the hemoglobin level 24 hours after the
procedure. Results: The time-course curves of the ACT differed
significantly across the patients with apixaban (N=113), dabigatran
(N=130), edoxaban (N=144), and rivaroxaban (N=81), with its highest
level in the dabigatran group (P <0.001). The average ACT was
greater in the dabigatran group than in the other groups (312.3±34,
334.4±44, 308.1±41, and 305.8±34.7 sec; P <0.001). A
significant difference was noted in total heparin requirement across the
patient groups (3990.2±1167.9, 3890.4±955.3, 4423.8±1051.6, and
3972±978.7 U/m2/h; P <0.001), with its greatest amount in the
edoxaban group. The reduction in the hemoglobin level was similar
(-0.93±0.92, -0.88±0.79, -0.89±0.97, -0.95±1.23 g/dL; P=0.94). No
inter-group difference was noted in the rate of major or minor bleedings
(0.9%, 2.3%, 1.4%, and 3.7%; P=0.51), and no thromboembolic events
were encountered. Conclusion: A difference in DOACs may have an impact
on intraablation anticoagulation, however, it may not on the procedural
blood loss in the setting of a single skip.