35\u2005Uninterrupted edoxaban versus rivaroxaban versus vitamin K antagonists for ablation of atrial fibrillation

Abstract

Background Catheter ablation in patients with atrial fibrillation/flutter is associated with a risk of stroke and major bleeding. We examined the safety and efficacy of uninterrupted anticoagulation with Edoxaban in patients undergoing atrial fibrillation/flutter ablation. Methods A retrospective analysis of 228 patients undergoing a catheter ablation for atrial flutter or atrial fibrillation over a 14 month period was performed (table 1). The warfarin group (n=86) included 52 males and 34 females with a mean age of 68.5±years and a mean CHADS-Vasc Score of 2.43±1.34. The Edoxaban group (n=63) included 45 males and 18 females with mean age 63.4±10.6 years and a mean CHADS-Vasc Score of 1.68±1.34. The Rivaroxaban group (n=79) included 56 males and 23 females, mean age 62.3±11.6 years and a CHADS- Vasc Score of 1.64±1.38. The mean left atrial sizes were 42.7±6.8 mm, 42.0±6 mm and 41.1±6.5 mm respectively (P value=0.473). All patients received uninterrupted oral anticoagulation for at least 4 weeks prior to the ablation and for a minimum of 3 months post procedure. Both bleeding and thromboembolic complications were assessed at 24 hours.Abstract 35 Table 1 Procedure Characteristics: Continuous variables reported as a mean±standard deviation (SD) Procedure Characteristics Warfarin N=86 Edoxaban N=63 P value vs warfarin Rivaroxaban N=79 P value vs warfarin AF ablation only 70 42 0.996 53 0.989 Flutter ablation only 13 18 0.988 17 0.999 Combination AF/Flutter 3 3 0.868 9 0.332 Flutter Type Typical 14 19 0.999 21 0.990 Atypical 2 2 0.977 5 0.375 AF type Paroxysmal 27 21 0.467 36 0.152 Persistent 59 24 0.595 27 0.415 Type of Anaesthesia Local 46 36 0.304 48 0.592 General 40 27 0.225 31 0.797 Energy used Laser 13 18 0.154 21 0.235 Cryoablation 4 9 0.825 2 0.945 RF 69 36 0.986 56 0.156 Type of Procedure Denovo 53 46 0.988 70 0.571 Redo 33 17 0.463 9 0.862 INR if applicable Less than 2 2 - - - - 2-3 81 - - - - More than 3 3 - - - - Closure Manual only 6 4 0.994 3 0.992 z-Suture only 5 12 0.991 4 0.998 Femstop only 71 44 0.993 71 0.996 Combination 4 3 0.991 1 0.992 Fluoroscopy Dose mgy 71.8 49.7 0.006 57.4 0.661 Fluoroscopy time min 16.5 14.8 0.152 14.8 0.175 Results Data between the Warfarin, Rivaroxaban and Edoxaban groups were analysed using a multivariate analysis. Warfarin was used as the reference group with age and gender as covariates. Acute thromboembolic, bleeding and other less common complications were compared (table 2). There were 4 complications (4.6%) in the warfarin, 2 (2.5%) in the Rivaroxaban and 2 (3%) in the Edoxaban groups, respectively. (P value=0.9).Abstract 35 Table 2 Acute complications: Table showing complications during and 24 hours following procedures for the Edoxaban and Rivaroxaban compared to warfarin. Note there was no significant difference between the three groups in terms of primary endpoints of major bleeding and thromboembolic complications. Categorical data were represented as numbers. CVA: Cerebrovascular accident, TIA: Transient ischemic attack, PCI: percutaneous coronary intervention. Acute complications Warfarin N=86 Edoxaban N=63 P value vs warfarin Rivaroxaban N=79 P value vs warfarin CVA/TIA 0 0 - 1 0.995 Pericardial Effusion 1 1 0.959 1 0.881 Groin Hematoma 2 1 0.998 0 1.000 Groin Pseudoaneurysm 0 0 - 0 - Urgent Intervention 1 (PCI) 0 0.998 0 0.995 Conclusion This retrospective study demonstrated that uninterrupted Edoxaban is as safe and effective as warfarin and Rivaroxaban in patients undergoing atrial fibrillation/ flutter ablations. There was no significant difference in acute bleeding and thromboembolic complications.