Warfarin is not needed in low-risk patients following atrial fibrillation ablation procedures

T. Jared Bunch, Brian G. Crandall, J. Peter Weiss, Heidi T. May, Tami L. Bair, Jeffrey S. Osborn, Jeffrey L. Anderson, Donald L. Lappe, J. Brent Muhlestein, Jennifer Nelson, Scott Allison, Thomas Foley, Lars Anderson, John D. Day

Research output: Contribution to journalArticle

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Abstract

Warfarin Is Not Needed in Low-Risk Patients. Background: The recently published HRS/EHRA/ECAS AF Ablation Consensus Statement recommended that warfarin should be used for at least 2 months following an AF ablation in all patients regardless of stroke risk factors. The objective of the study was to assess outcomes based upon anticoagulation practice after atrial fibrillation (AF) ablation to determine relative risk of a strategy of aspirin only in low-risk patients. Methods: A total of 630 consecutive patients who underwent 934 ablation procedures using an open irrigated tip catheter for symptomatic AF were evaluated. Outcomes were compared between patients treated with warfarin (goal INR: 2-3) versus aspirin only (325 mg/day) in CHADS2 0-1 patients after ablation. Results: Of the 690 patients, 123 (20%) were treated with aspirin and 507 (80%) with warfarin. Prevalences of the CHADS2 scores of patients on aspirin were (0: 40.7%, 1: 59.3%) and on warfarin (0: 13.6%, 1: 31.6%, ≥2: 54.8%), P < 0.0001. Patients in the warfarin group were older, had on average a lower ejection fraction, and had higher rates persistent/permanent AF, repeat ablations, hypertension, prior stroke/TIA, and diabetes. The 1-year survival free of AF for the total study population was 71.6%. There were no strokes/TIA in the aspirin group and 4 events (4 strokes, 0 TIAs) in the warfarin group. Two patients in the warfarin group died of fatal hemorrhage (1 intracranial, 1 gastrointestinal). Conclusion: Select low-risk patients with a low CHADS2 (0-1) score who undergo left atrial ablation with an aggressive anticoagulation strategy with heparin and use of an open irrigated tip catheter with low CHADS2 scores can safely be discharged following their procedure on aspirin alone. (J Cardiovasc Electrophysiol, Vol. 20, pp. 988-993)

Original languageEnglish (US)
Pages (from-to)988-993
Number of pages6
JournalJournal of Cardiovascular Electrophysiology
Volume20
Issue number9
DOIs
StatePublished - Sep 2009
Externally publishedYes

Fingerprint

Warfarin
Atrial Fibrillation
Aspirin
Stroke
Catheters
International Normalized Ratio
Intracranial Hemorrhages
Heparin
Hypertension
Survival

Keywords

  • Ablation
  • Anticoagulants
  • Atrial Fibrillation
  • Stroke
  • Warfarin

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Bunch, T. J., Crandall, B. G., Weiss, J. P., May, H. T., Bair, T. L., Osborn, J. S., ... Day, J. D. (2009). Warfarin is not needed in low-risk patients following atrial fibrillation ablation procedures. Journal of Cardiovascular Electrophysiology, 20(9), 988-993. https://doi.org/10.1111/j.1540-8167.2009.01481.x

Warfarin is not needed in low-risk patients following atrial fibrillation ablation procedures. / Bunch, T. Jared; Crandall, Brian G.; Weiss, J. Peter; May, Heidi T.; Bair, Tami L.; Osborn, Jeffrey S.; Anderson, Jeffrey L.; Lappe, Donald L.; Muhlestein, J. Brent; Nelson, Jennifer; Allison, Scott; Foley, Thomas; Anderson, Lars; Day, John D.

In: Journal of Cardiovascular Electrophysiology, Vol. 20, No. 9, 09.2009, p. 988-993.

Research output: Contribution to journalArticle

Bunch, TJ, Crandall, BG, Weiss, JP, May, HT, Bair, TL, Osborn, JS, Anderson, JL, Lappe, DL, Muhlestein, JB, Nelson, J, Allison, S, Foley, T, Anderson, L & Day, JD 2009, 'Warfarin is not needed in low-risk patients following atrial fibrillation ablation procedures', Journal of Cardiovascular Electrophysiology, vol. 20, no. 9, pp. 988-993. https://doi.org/10.1111/j.1540-8167.2009.01481.x
Bunch, T. Jared ; Crandall, Brian G. ; Weiss, J. Peter ; May, Heidi T. ; Bair, Tami L. ; Osborn, Jeffrey S. ; Anderson, Jeffrey L. ; Lappe, Donald L. ; Muhlestein, J. Brent ; Nelson, Jennifer ; Allison, Scott ; Foley, Thomas ; Anderson, Lars ; Day, John D. / Warfarin is not needed in low-risk patients following atrial fibrillation ablation procedures. In: Journal of Cardiovascular Electrophysiology. 2009 ; Vol. 20, No. 9. pp. 988-993.
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abstract = "Warfarin Is Not Needed in Low-Risk Patients. Background: The recently published HRS/EHRA/ECAS AF Ablation Consensus Statement recommended that warfarin should be used for at least 2 months following an AF ablation in all patients regardless of stroke risk factors. The objective of the study was to assess outcomes based upon anticoagulation practice after atrial fibrillation (AF) ablation to determine relative risk of a strategy of aspirin only in low-risk patients. Methods: A total of 630 consecutive patients who underwent 934 ablation procedures using an open irrigated tip catheter for symptomatic AF were evaluated. Outcomes were compared between patients treated with warfarin (goal INR: 2-3) versus aspirin only (325 mg/day) in CHADS2 0-1 patients after ablation. Results: Of the 690 patients, 123 (20{\%}) were treated with aspirin and 507 (80{\%}) with warfarin. Prevalences of the CHADS2 scores of patients on aspirin were (0: 40.7{\%}, 1: 59.3{\%}) and on warfarin (0: 13.6{\%}, 1: 31.6{\%}, ≥2: 54.8{\%}), P < 0.0001. Patients in the warfarin group were older, had on average a lower ejection fraction, and had higher rates persistent/permanent AF, repeat ablations, hypertension, prior stroke/TIA, and diabetes. The 1-year survival free of AF for the total study population was 71.6{\%}. There were no strokes/TIA in the aspirin group and 4 events (4 strokes, 0 TIAs) in the warfarin group. Two patients in the warfarin group died of fatal hemorrhage (1 intracranial, 1 gastrointestinal). Conclusion: Select low-risk patients with a low CHADS2 (0-1) score who undergo left atrial ablation with an aggressive anticoagulation strategy with heparin and use of an open irrigated tip catheter with low CHADS2 scores can safely be discharged following their procedure on aspirin alone. (J Cardiovasc Electrophysiol, Vol. 20, pp. 988-993)",
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AU - Crandall, Brian G.

AU - Weiss, J. Peter

AU - May, Heidi T.

AU - Bair, Tami L.

AU - Osborn, Jeffrey S.

AU - Anderson, Jeffrey L.

AU - Lappe, Donald L.

AU - Muhlestein, J. Brent

AU - Nelson, Jennifer

AU - Allison, Scott

AU - Foley, Thomas

AU - Anderson, Lars

AU - Day, John D.

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