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Periprocedural NOAC

Amish N Raval, Joaquin E Cigarroa, Mina K Chung, Larry J Diaz-Sandoval, Deborah Diercks, Jonathan P Piccini, Hee Soo Jung, Jeffrey B Washam, Babu G Welch, Allyson R Zazulia, Sean P Collins
Non-vitamin K oral anticoagulants (NOACs) are now widely used as alternatives to warfarin for stroke prevention in atrial fibrillation and management of venous thromboembolism. In clinical practice, there is still widespread uncertainty on how to manage patients on NOACs who bleed or who are at risk for bleeding. Clinical trial data related to NOAC reversal for bleeding and perioperative management are sparse, and recommendations are largely derived from expert opinion. Knowledge of time of last ingestion of the NOAC and renal function is critical to managing these patients given that laboratory measurement is challenging because of the lack of commercially available assays in the United States...
March 7, 2017: Circulation
Yue Zhao, Yuan Yang, Xuejiao Tang, Xiang Yu, Lei Zhang, Hua Xiao
BACKGROUND: New oral anticoagulants (NOACs) have been shown to be comparable to warfarin in patients with non-valvular atrial fibrillation (AF). This meta-analysis was performed to evaluate the efficacy and safety of NOACs for perioperative anticoagulation of AF catheter ablation. METHODS: PubMed, Embase, the Cochrane Library, CNKI, VIP, and SinoMed were searched for articles published up to August 30, 2015. The data were calculated with RevMan 5.2 using a fixed-effects model...
January 12, 2017: Journal of Interventional Cardiac Electrophysiology: An International Journal of Arrhythmias and Pacing
M Buerke, H M Hoffmeister
Many patients under oral anticoagulation therapy need percutaneous or surgical interventions/operations. For vitamin K antagonists (VKA), there are recommendations regarding preoperative or postoperative administration. Management of the new oral anticoagulants (NOAC) was supposed to be easier - but some aspects must be considered. Due to the different pharmacokinetic profiles of substances such as dabigatran, rivaroxaban, apixaban, and edoxaban, different recommendations are given.Upon periprocedural management, thromboembolic risk has to be considered in patients treated with NOACs...
January 10, 2017: Medizinische Klinik, Intensivmedizin und Notfallmedizin
Pavel Osmancik, Petr Tousek, Dalibor Herman, Petr Neuzil, Pavel Hala, Josef Stasek, Ludek Haman, Petr Kala, Martin Poloczek, Marian Branny, Jan Chovancik, Pavel Cervinka, Jiri Holy, Vlastimil Vancura, Richard Rokyta, Milos Taborsky, Tomas Kovarnik, David Zemanek, Petr Peichl, Sarka Haskova, Jiri Jarkovsky, Petr Widimsky
Atrial fibrillation (AF), with a prevalence of 1% to 2%, is the most common cardiac arrhythmia. Without antithrombotic treatment, the annual risk of a cardioembolic event is 5% to 6%. The source of a cardioembolic event is a thrombus, which is usually formed in the left atrial appendage (LAA). Prevention of cardioembolic events involves treatment with anticoagulant drugs: either vitamin K antagonists or, recently, novel oral anticoagulants (NOAC). The other (nonpharmacologic) option for the prevention of a cardioembolic event involves interventional occlusion of the LAA...
January 2017: American Heart Journal
Melanie Gunawardene, S Willems, B Schäffer, J Moser, R Ö Akbulak, M Jularic, C Eickholt, J Nührich, C Meyer, P Kuklik, S Sehner, V Czerner, B A Hoffmann
BACKGROUND: The use of non-vitamin K antagonists (NOACs), uninterrupted (uVKA) and interrupted vitamin K antagonists (iVKA) are common periprocedural oral anticoagulation (OAC) strategies for atrial fibrillation (AF) ablation. Comparative data on complication rates resulting from OAC strategies for solely persistent AF (persAF) undergoing ablation are sparse. Thus, we sought to determine the impact of these OAC strategies on complication rates among patients with persAF undergoing catheter ablation...
January 2017: Clinical Research in Cardiology: Official Journal of the German Cardiac Society
Hany S Abed, Vivien Chen, Michael J Kilborn, Raymond W Sy
Oral anticoagulation (OAC) has been the cornerstone for the prevention of thromboembolic complications in patients with atrial fibrillation (AF) at significant risk of stroke. Catheter ablation is an established efficacious technique for the treatment of AF. Ameliorating the risk of stroke or transient ischaemic attack (TIA) in patients with AF undergoing ablation requires meticulous planning of pharmacotherapy. The advent of non-vitamin K oral anticoagulants (NOACs) has broadened the therapeutic scope, representing a viable alternative to traditional vitamin K antagonists (VKA) in non-valvular AF...
December 2016: Heart, Lung & Circulation
Hirosuke Yamaji, Takashi Murakami, Kazuyoshi Hina, Shunich Higashiya, Hiroshi Kawamura, Masaaki Murakami, Shigeshi Kamikawa, Issei Komtasubara, Shozo Kusachi
BACKGROUND AND OBJECTIVE: During atrial fibrillation ablation, heparin is required and is guided by the activated clotting time (ACT). Differences in the ACT before ablation and adequate initial heparin dosing in patients receiving non-vitamin K antagonist oral anticoagulants (NOACs) were examined. METHODS: Patients who received warfarin (control, N = 90), dabigatran etexilate (N = 90), rivaroxaban (N = 90) and apixaban (N = 90) were studied. A 100 U/kg dose of heparin was administered as a reliable control dose for warfarin, and the remaining patients were randomly administered 110, 120 or 130 U/kg of heparin in each NOAC group, followed by a continuous heparin infusion...
October 2016: Clinical Drug Investigation
Suneel D Kamath, Brandon J McMahon
The novel oral anticoagulants (NOACs) represent a major advance in the treatment of patients with nonvalvular atrial fibrillation and venous thromboembolism (VTE). They have several advantages over vitamin-K antagonists such as warfarin, including more predictable pharmacokinetics and improved safety, particularly with fatal bleeding and intracranial hemorrhage. However, several issues remain surrounding the use of NOACs in certain subpopulations and with the approach to reversal. The periprocedural management of anticoagulation with these relatively new agents can also present several challenges...
June 2016: Seminars in Interventional Radiology
Andrea Santucci, Robert A Byrne, Andreas Baumbach, Roisin Colleran, Michael Haude, Stephan Windecker, Marco Valgimigli
AIMS: The aim of this study was to determine the opinion of the scientific community regarding percutaneous left atrial appendage closure (LAAC). The main focus of the survey was on concerns and expectations regarding the safety and efficacy profile of LAAC in clinical practice and on current and future clinical perspectives. METHODS AND RESULTS: A voluntary web-based survey was distributed by the European Association of Percutaneous Coronary Interventions (EAPCI) to all individuals registered on the EuroIntervention mailing list (n=21,800)...
May 17, 2016: EuroIntervention
Akino Yoshimura, Yasuhisa Iriki, Hitoshi Ichiki, Naoya Oketani, Hideki Okui, Ryuichi Maenosono, Fuminori Namino, Masaaki Miyata, Mitsuru Ohishi
BACKGROUND: We previously reported that dabigatran increased the risk of microthromboembolism and hemopericardium compared with warfarin. The safety of non-vitamin-K-antagonist oral anticoagulants (NOACs) in the periprocedural use of atrial fibrillation (AF) ablation is controversial. This study aimed to compare the incidence of asymptomatic cerebral microthromboembolism and hemopericardium in AF ablation among periprocedural use of rivaroxaban, apixaban, and warfarin. METHODS AND RESULTS: This study was a prospective, randomized registry...
January 2017: Journal of Cardiology
Ajay Vallakati, Abhishek Sharma, Mohammed Madmani, Madhu Reddy, Arun Kanmanthareddy, Sampath Gunda, Dhanunjaya Lakkireddy, William R Lewis
INTRODUCTION: Novel oral anticoagulants (NOACs) have been approved for prevention of stroke and systemic embolism in patients with non-valvular atrial fibrillation (NVAF). A large number of patients are on NOACs when they present for AF ablation. We intended to evaluate the safety and efficacy of NOACs for AF ablation during the periprocedural period by performing a meta-analysis of trials comparing NOACs with warfarin. METHODS: Studies comparing NOACs (dabigatran and rivaroxaban) with warfarin as periprocedural anticoagulants for AF ablation were identified using an electronic search...
June 2016: Cardiology and Therapy
Patrick Müller, Philipp Halbfass, Attila Szöllösi, Johannes-Wolfgang Dietrich, Franziska Fochler, Karin Nentwich, Markus Roos, Joachim Krug, Rainer Schmitt, Andreas Mügge, Thomas Deneke
BACKGROUND: Silent cerebral events (SCEs) have been observed on diffusion-weighted cerebral magnetic resonance imaging (MRI) in a substantial number of asymptomatic patients after atrial fibrillation (AF) ablation procedures. The purpose of this study was to investigate if periprocedural oral anticoagulation (OAC) management affects the incidence of new-onset SCE after radiofrequency catheter ablation (RFCA) of AF. METHODS AND RESULTS: One hundred ninety-two consecutive patients (64 ± 10...
September 2016: Journal of Interventional Cardiac Electrophysiology: An International Journal of Arrhythmias and Pacing
David F Briceno, Pedro A Villablanca, Florentino Lupercio, Faraj Kargoli, Anand Jagannath, Alejandra Londono, Jignesh Patel, Olufisayo Otusanya, Jeannine Brevik, Carola Maraboto, Cecilia Berardi, Andrew Krumerman, Eugen Palma, Soo G Kim, Andrea Natale, Luigi DI Biase
INTRODUCTION: Appropriate activated clotting time (ACT) during catheter ablation of atrial fibrillation (CA-AF) is essential to minimize periprocedural complications. METHODS AND RESULTS: An electronic search was performed using major databases. Outcomes were thromboembolic (TE) and bleeding complications according to ACT levels (seconds). Heparin dose (U/kg) and time (minutes) to achieve the target ACT was compared among patients receiving vitamin K antagonist (VKA) versus non-VKA oral anticoagulants (NOAC)...
June 2016: Journal of Cardiovascular Electrophysiology
Christian M Lange, Stephan Fichtlscherer, Wolfgang Miesbach, Stefan Zeuzem, Jörg Albert
BACKGROUND: In Germany, more than half a million persons, most of them elderly, are under long-term treatment with anticoagulants. The approval of new oral anticoagulants and platelet aggregation inhibitors, as well as new data on periprocedural bridging with heparins, have introduced marked complexity to the management of treatment with anticoagulants and platelet aggregation inhibitors for endoscopic interventions in visceral surgery. METHODS: This review is based on pertinent publications retrieved by a selective literature search in PubMed, as well as on the relevant guidelines...
February 26, 2016: Deutsches Ärzteblatt International
Tiffany Y Hu, Vaibhav R Vaidya, Samuel J Asirvatham
Novel oral anticoagulants (NOACs) are increasingly used in clinical practice, but lack of commercially available reversal agents is a major barrier for mainstream use of these therapies. Specific antidotes to NOACs are under development. Idarucizumab (aDabi-Fab, BI 655075) is a novel humanized mouse monoclonal antibody that binds dabigatran and reverses its anticoagulant effect. In a recent Phase III study (Reversal Effects of Idarucizumab on Active Dabigatran), a 5 g intravenous infusion of idarucizumab resulted in the normalization of dilute thrombin time in 98% and 93% of the two groups studied, with normalization of ecarin-clotting time in 89% and 88% patients...
2016: Vascular Health and Risk Management
Buelent Koektuerk, Cem H Turan, Hikmet Yorgun, Kerim Keskin, Moritz Schoett, Alina Dahmen, Eduard Gorr, Alexander Yang, Christian Hoppe, Marc Horlitz, Ramazan G Turan
AIM: Data evaluating the complications of pulmonary vein isolation (PVI) using second-generation cryoballoons (CB) related to different anticoagulation regimes are limited. This study evaluates the total complications and the impact of novel oral anticoagulants (NOACs) compared to phenprocoumon on adverse events in the setting of PVI using CB. METHODS AND RESULTS: PVI was performed using second-generation CB by two experienced investigators. A total of 409 patients (58...
June 2016: Cardiovascular Therapeutics
Peter Steen Hansen, Ricardo Sanchez, Håkan Walfridsson
INTRODUCTION: Limited data are available regarding safety of catheter ablation of atrial fibrillation (AF) in patients using novel oral anticoagulants (NOAC) before and after pulmonary vein isolation. We aimed to assess the safety of a simple anticoagulation protocol in consecutive patients presenting for catheter ablation of AF. METHODS: From November 2011 to December 2014, we prospectively included 234 patients referred for catheter ablation of AF who had already received NOAC treatment...
February 2016: Danish Medical Journal
Andreas Rillig, Tina Lin, Joaquina Plesman, Christian-H Heeger, Christine Lemes, Andreas Metzner, Shibu Mathew, Erik Wissner, Peter Wohlmuth, Feifan Ouyang, Karl-Heinz Kuck, Roland Richard Tilz
INTRODUCTION: Data on the novel oral anticoagulants (NOACS) during catheter ablation (CA) of atrial fibrillation (AF) are still limited. This study evaluated the periprocedural major complications (MC) of CA of AF, and compared Apixaban, Dabigatran, and Rivaroxaban with continuous phenoprocoumon. METHODS AND RESULTS: A total of 444 patients (mean age = 65.1 ± 9.4 years; 283 [64%] male) with paroxysmal (n = 180 [41%]), persistent (n = 256 [58%]), or longstanding-persistent AF were enrolled...
February 2016: Journal of Cardiovascular Electrophysiology
Philip L Mar, Dmitry Familtsev, Michael D Ezekowitz, Dhanunjaya Lakkireddy, Rakesh Gopinathannair
An increasing number of individuals are on novel oral anticoagulants (NOAC) for anticoagulation instead of vitamin K antagonists (VKA) and roughly 10% of these individuals will require interruption of these agents for procedures annually. Recent evidence surrounding bridging as well as the FDA approval of a new NOAC call for a comprehensive review and update regarding periprocedural NOAC management. The periprocedural management of NOACs involves striking a balance between the risks of bleeding and thromboembolism associated with interruption, bridging, and reinitiation of anticoagulation...
January 1, 2016: International Journal of Cardiology
Yuji Murakawa, Akihiko Nogami, Morio Shoda, Koichi Inoue, Shigeto Naito, Koichiro Kumagai, Yasushi Miyauchi, Teiichi Yamane, Norishige Morita, Hideo Mitamura, Ken Okumura
BACKGROUND: Catheter ablation has become an established therapy for the treatment of atrial fibrillation (AF). To obtain a perspective on the current status of this therapy in Japan, the Japanese Heart Rhythm Society (JHRS) conducted a nationwide survey, the Japanese Catheter Ablation Registry of Atrial Fibrillation (J-CARAF). In this study, we focused on whether periprocedural use of novel oral anticoagulants (NOACs) was related with excessive thromboembolic or bleeding complications...
February 2015: Journal of Arrhythmia
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