Skip to main content
SpringerLink
Log in

Clinical experience of uninterrupted oral anticoagulants during atrial fibrillation ablation in elderly patients: a comparison with non-elderly patients

  • Original Article
  • Published:
Heart and Vessels Aims and scope Submit manuscript

Abstract

It is unclear whether uninterrupted oral anticoagulants (OACs) are acceptable in elderly patients as compared to non-elderly patients. This study aimed to assess the clinical impact of an uninterrupted OAC strategy during atrial fibrillation (AF) ablation in elderly patients. We enrolled 439 consecutive patients who underwent AF ablation with an uninterrupted OAC strategy at our institute. The incidence of bleeding and thromboembolic complications during the AF ablation or within 4 weeks after and the anticoagulation status during the AF ablation were compared between the elderly (age ≧ 75, n = 144) and non-elderly groups (n = 295). There were 22 bleeding complications in the elderly group and 31 in the non-elderly group (15% vs. 11%, p = 0.162) and 3 major bleeding complications in the elderly group and 2 in the non-elderly group (2% vs. 0.7%, p = 0.336). Thromboembolic events were observed in 1 patient in the elderly group and 2 in the non-elderly group (0.7% vs. 0.7%, p = 1.000). The ACT at the end of the procedure was longer in the elderly group than in the non-elderly group (350 s vs. 341 s, p = 0.007) and the proportion of a prolonged ACT of > 400 s (27% vs. 18%, p = 0.046) was more frequent in the elderly group than non-elderly group. A propensity score matched population excluding the age and body weight, revealed that the anticoagulation status during AF ablation was comparable between the two groups. Thus, in the patients undergoing AF ablation with uninterrupted OAC strategy, bleeding complications in elderly patients were similar to those in non-elderly patients. The anticoagulation status during the procedure in elderly patients was more prolonged than that in non-elderly patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. Di Biase L, Burkhardt JD, Santangeli P, Mohanty P, Sanchez JE, Horton R, Gallinghouse GJ, Themistoclakis S, Rossillo A, Lakkireddy D, Reddy M, Hao S, Hongo R, Beheiry S, Zagrodzky J, Rong B, Mohanty S, Elayi CS, Forleo G, Pelargonio G, Narducci ML, Dello Russo A, Casella M, Fassini G, Tondo C, Schweikert RA, Natale A (2014) Periprocedural stroke and bleeding complications in patients undergoing catheter ablation of atrial fibrillation with different anticoagulation management: results from the role of coumadin in preventing thromboembolism in atrial fibrillation (AF) patients undergoing catheter ablation (COMPARE) randomized trial. Circulation 129:2638–2644

    Article  Google Scholar 

  2. Calkins H, Willems S, Gerstenfeld EP, Verma A, Schilling R, Hohnloser SH, Okumura K, Serota H, Nordaby M, Guiver K, Biss B, Brouwer MA, Grimaldi M (2017) Uninterrupted dabigatran versus warfarin for ablation in atrial fibrillation. N Engl J Med 376:1627–1636

    Article  CAS  Google Scholar 

  3. Cappato R, Marchlinski FE, Hohnloser SH, Naccarelli GV, Xiang J, Wilber DJ, Ma CS, Hess S, Wells DS, Juang G, Vijgen J, Hügl BJ, Balasubramaniam R, De Chillou C, Davies DW, Fields LE, Natale A (2015) Uninterrupted rivaroxaban vs. uninterrupted vitamin K antagonists for catheter ablation in non-valvular atrial fibrillation. Eur Heart J 36:1805–1811

    Article  CAS  Google Scholar 

  4. Kirchhof P, Haeusler KG, Blank B, De Bono J, Callans D, Elvan A, Fetsch T, Van Gelder IC, Gentlesk P, Grimaldi M, Hansen J, Hindricks G, Al-Khalidi HR, Massaro T, Mont L, Nielsen JC, Nölker G, Piccini JP, De Potter T, Scherr D, Schotten U, Themistoclakis S, Todd D, Vijgen J, Di Biase L (2018) Apixaban in patients at risk of stroke undergoing atrial fibrillation ablation. Eur Heart J 39:2942–2955

    Article  CAS  Google Scholar 

  5. Hohnloser SH, Camm J, Cappato R, Diener HC, Heidbüchel H, Mont L, Morillo CA, Abozguia K, Grimaldi M, Rauer H, Reimitz PE, Smolnik R, Mönninghoff C, Kautzner J (2019) Uninterrupted edoxaban vs. vitamin K antagonists for ablation of atrial fibrillation: the ELIMINATE-AF trial. Eur Heart J 40:3013–3021

    Article  Google Scholar 

  6. Perera V, Bajorek BV, Matthews S, Hilmer SN (2009) The impact of frailty on the utilisation of antithrombotic therapy in older patients with atrial fibrillation. Age Ageing 38:156–162

    Article  Google Scholar 

  7. Kato ET, Giugliano RP, Ruff CT, Koretsune Y, Yamashita T, Kiss RG, Nordio F, Murphy SA, Kimura T, Jin J, Lanz H, Mercuri M, Braunwald E, Antman EM (2016) Efficacy and safety of edoxaban in elderly patients with atrial fibrillation in the ENGAGE AF-TIMI 48 trial. J Am Heart Assoc. https://doi.org/10.1161/JAHA.116.003432

    Article  PubMed  PubMed Central  Google Scholar 

  8. Yanagisawa S, Inden Y, Fujii A, Ando M, Funabiki J, Murase Y, Takenaka M, Otake N, Ikai Y, Sakamoto Y, Shibata R, Murohara T (2018) Uninterrupted direct oral anticoagulant and warfarin administration in elderly patients undergoing catheter ablation for atrial fibrillation: a comparison with younger patients. JACC Clin electrophysiol 4:592–600

    Article  Google Scholar 

  9. Guidelines for pharmacotherapy of atrial fibrillation (JCS 2013) (2014). Circ J 78:1997–2021.

  10. Okada M, Inoue K, Tanaka K, Ninomiya Y, Hirao Y, Oka T, Tanaka N, Inoue H, Nakamaru R, Koyama Y, Okamura A, Iwakura K, Sakata Y, Fujii K (2018) Efficacy and safety of figure-of-eight suture for hemostasis after radiofrequency catheter ablation for atrial fibrillation. Circ J 82:956–964

    Article  CAS  Google Scholar 

  11. Schulman S, Kearon C (2005) Definition of major bleeding in clinical investigations of antihemostatic medicinal products in non-surgical patients. J Thromb Haemost 3:692–694

    Article  CAS  Google Scholar 

  12. Park CS, Choi EK, Kim HM, Lee SR, Cha MJ, Oh S (2017) Increased risk of major bleeding in underweight patients with atrial fibrillation who were prescribed non-vitamin K antagonist oral anticoagulants. Heart Rhythm 14:501–507

    Article  Google Scholar 

  13. Nademanee K, Amnueypol M, Lee F, Drew CM, Suwannasri W, Schwab MC, Veerakul G (2015) Benefits and risks of catheter ablation in elderly patients with atrial fibrillation. Heart Rhythm 12:44–51

    Article  Google Scholar 

  14. Bunch TJ, Weiss JP, Crandall BG, May HT, Bair TL, Osborn JS, Anderson JL, Lappe DL, Muhlestein JB, Nelson J, Day JD (2010) Long-term clinical efficacy and risk of catheter ablation for atrial fibrillation in octogenarians. Pacing Clin Electrophysiol 33:146–152

    Article  Google Scholar 

  15. Santangeli P, Di Biase L, Mohanty P, Burkhardt JD, Horton R, Bai R, Mohanty S, Pump A, Gibson D, Couts L, Hongo R, Beheiry S, Natale A (2012) Catheter ablation of atrial fibrillation in octogenarians: safety and outcomes. J Cardiovasc Electrophysiol 23:687–693

    Article  Google Scholar 

  16. Nakamura K, Naito S, Sasaki T, Take Y, Minami K, Kitagawa Y, Motoda H, Inoue M, Otsuka Y, Niijima K, Yamashita E, Sugai Y, Kumagai K, Koyama K, Funabashi N, Oshima S (2019) Uninterrupted vs. interrupted periprocedural direct oral anticoagulants for catheter ablation of atrial fibrillation: a prospective randomized single-centre study on post-ablation thrombo-embolic and haemorrhagic events. Europace 21:259–267

    Article  Google Scholar 

  17. Mizutani Y, Kanashiro M, Makino Y, Satake A, Suzuki W, Kurobe M, Mizutani K, Ichimiya H, Uchida Y, Watanabe J, Ichimiya S, Inden Y, Murohara T (2020) Earliest pulmonary vein potential-guided cryoballoon ablation for atrial fibrillation. Heart Vessels 35:232–238

    Article  Google Scholar 

  18. Matsunaga-Lee Y, Egami Y, Yanagawa K, Nakamura H, Matsuhiro Y, Yasumoto K, Tanaka A, Okamoto N, Nakamura D, Yano M, Yamato M, Shutta R, Sakata Y, Nishino M, Tanouchi J (2020) Limited efficacy of a figure-of-eight suture for hemostasis after cryoballoon atrial fibrillation ablation with uninterrupted oral anticoagulants. J Cardiol. https://doi.org/10.1016/j.jjcc.2020.01.012

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors thank Mr. John Martin for his linguistic assistance with this manuscript.

Funding

None.

Author information

Authors and Affiliations

  1. Division of Cardiology, Osaka Rosai Hospital, 3-1179 Nagasonecho, kita-ku, Sakai, Osaka, Japan

    Yasuharu Matsunaga-Lee, Yasuyuki Egami, Kyosuke Yanagawa, Hitoshi Nakamura, Yutaka Matsuhiro, Koji Yasumoto, Masaki Tsuda, Naotaka Okamoto, Akihiro Tanaka, Masamichi Yano, Masaki Yamato, Ryu Shutta, Masami Nishino & Jun Tanouchi

  2. Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan

    Yasushi Sakata

Authors
  1. Yasuharu Matsunaga-Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yasuyuki Egami
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kyosuke Yanagawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hitoshi Nakamura
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yutaka Matsuhiro
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Koji Yasumoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Masaki Tsuda
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Naotaka Okamoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Akihiro Tanaka
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Masamichi Yano
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Masaki Yamato
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Ryu Shutta
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Yasushi Sakata
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Masami Nishino
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Jun Tanouchi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Masami Nishino.

Ethics declarations

Conflict of interest

The authors declare no Conflict of Interests for this article.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Matsunaga-Lee, Y., Egami, Y., Yanagawa, K. et al. Clinical experience of uninterrupted oral anticoagulants during atrial fibrillation ablation in elderly patients: a comparison with non-elderly patients. Heart Vessels 35, 1454–1462 (2020). https://doi.org/10.1007/s00380-020-01615-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00380-020-01615-y

Keywords

Search

Navigation