Safety of Continuous Periprocedural Rivaroxaban for Patients Undergoing Left Atrial Catheter Ablation Procedures
Background—This study aimed to evaluate the safety of continuous periprocedural rivaroxaban administration during left atrial RFA in comparison with uninterrupted oral vitamin K antagonist (VKA) administration. Data about the use of rivaroxaban in the setting of left atrial radiofrequency catheter ablation (RFA) procedures are lacking.
Methods and Results—The study cohort included 544 patients (mean age 63±10 years) who underwent left atrial RFA procedures between February 2012 and May 2013. All patients (n=272) receiving uninterrupted periprocedural rivaroxaban 15 or 20 mg/day before the procedure (RivG) were matched by age, sex, and type of rhythm disorder with an equal number of patients managed with uninterrupted VKA phenprocoumon (PhenG) (INR 2-3). During RFA, heparin i.v. was given to maintain an activated clotting time (ACT) at 270-300 seconds. The safety endpoint was a composite of bleeding, thromboembolic events and death. There were no thromboembolic complications and no deaths in either group. The prevalence of major bleeding complications was similar in both groups (one tamponade in RivG and one groin hematoma requiring transfusion in PhenG). Minor bleeding complications occurred equally in both groups (20 of 272, 7% in the RivG vs. 33 of 272, 12% in the PhenG, p=0.08). In multivariable analyses female gender was associated with a greater risk of complications (OR 1.96, 95% CI 1.10-3.49).
Conclusions—In patients undergoing left atrial RFA, continuous periprocedural rivaroxaban use appears to be as safe as uninterrupted periprocedural phenprocoumon administration.
- Received January 21, 2014.
- Revision received May 22, 2014.
- Accepted May 25, 2014.