Heart Rhythm Society

Heart Rhythm Society

Issue: July 2013
May 22, 2013
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AF ablation without warfarin discontinuation reduced stroke and bleeding complications

Issue: July 2013
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DENVER — Performing catheter ablation of atrial fibrillation without warfarin discontinuation significantly reduced the occurrence of periprocedural stroke and bleeding complications, according to findings from the COMPARE trial.

COMPARE is the first open-label, parallel-group, multicenter study to assess the role of continuous warfarin therapy in the prevention of periprocedural thromboembolic and hemorrhagic events after radiofrequency catheter ablation. Researchers randomly assigned 1,584 patients to discontinue warfarin (n=790) or continue warfarin (n=794).

Luigi Di Biase, MD, PhD 

Luigi Di Biase

The primary endpoint was incidence of thromboembolic events in the 48 hours after ablation. In the discontinued-warfarin group, the incidence of periprocedural stroke was 3.7% (one in paroxysmal AF, two in persistent AF and 26 in longstanding persistent AF). In the continued-warfarin group, the incidence of periprocedural stroke was 0.225% (two in longstanding persistent AF with subtherapeutic international normalized ratio the day of procedure).

Multivariate analysis revealed that warfarin discontinuation was a strong predictor of periprocedural thromboembolic events (OR=13; 95% CI, 3.1-55.6). Other significant predictors included female sex, CHADS2 score and longstanding persistent AF.

The incidence of major bleeding complications and pericardial effusion was not different between the two groups. Incidence of minor bleeding complication was higher in the discontinued-warfarin group.

“The role of newer anticoagulants in this setting requires investigation, especially in high-risk patients, and should be compared only to on-warfarin treatment,” Luigi Di Biase, MD, PhD, from Texas Cardiac Arrhythmia Institute at St. David’s Medical Center in Austin and Albert Einstein College of Medicine at Montefiore Hospital in New York, said at the scientific session. – by Deb Dellapena

For more information:

Di Biase L. LB01-01. Presented at: Heart Rhythm Society’s Annual Scientific Sessions; May 8-11, 2013; Denver.

Disclosure: Di Biase reports consulting for Biosense Webster, Hansen Medical and St. Jude Medical.