The uninterrupted periprocedural administration of apixaban in patients with atrial fibrillation (AF) undergoing radiofrequency catheter ablation was effective in preventing thromboembolism, without increasing the risk of bleeding compared with uninterrupted warfarin. Luigi Di Biase, MD, PhD, Albert Einstein College of Medicine of Yeshiva University, Bronx, New York, USA, and Texas Cardiac Arrhythmia Institute, Austin, Texas, USA, presented a poster from a registry study that evaluated uninterrupted periprocedural administration of apixaban among patients with AF undergoing radiofrequency catheter ablation [Di Biase L et al. Heart Rhythm. 2015].

The current approach for anticoagulation in patients with AF undergoing radiofrequency catheter ablation is uninterrupted warfarin that maintains a therapeutic international normalized ratio. However, the role of the nonwarfarin oral anticoagulants, including the factor Xa inhibitors and direct thrombin inhibitors, during the periprocedural period in this population has not yet been established. The purpose of this study was to determine if the use of uninterrupted apixaban during the periprocedural period in patients with AF undergoing ablation was safe and feasible.

In this multicenter, prospective registry study, 400 patients with AF undergoing radiofrequency catheter ablation who received uninterrupted apixaban (n = 200) or warfarin (n = 200) were enrolled and matched according to age, sex, and type of AF. The dose of apixaban was 5 mg BID for ≥ 30 days prior to ablation, and the last dose was administered the morning of the procedure. At baseline, the mean age of the patients was 65.9, 71.5% of patients were men, and 83.5% of patients had nonparoxysmal AF.

There was no significant difference in bleeding rates among the study groups. Major bleeding occurred in 1% and 0.5% of patients in the apixaban and warfarin groups, respectively (P = 1.0). Similarly, minor bleeding occurred in 3.5% and 2.5% of patients in the apixaban and warfarin groups (P = .56), with the overall rate of bleeding at 4.5% and 3% (P = .43). There were no reports of symptomatic thromboembolism in either study groups. Among a subset of 29 patients who underwent diffusion magnetic resonance imaging in the apixaban-treated group, there were no signs of new silent cerebral ischemias.

In conclusion, Dr Di Biase stated that the data from this study suggest that uninterrupted apixaban administration is safe and feasible in patients with AF who are undergoing radiofrequency catheter ablation. He noted that in the present study, uninterrupted apixaban did not increase the risk of bleeding compared with warfarin and was effective in preventing thromboembolism.