The following is a summary of “Renal function and periprocedural complications in patients undergoing left atrial catheter ablation: A comparison between uninterrupted direct oral anticoagulants and phenprocoumon administration,” published in the January 2024 issue of Cardiology by Erhard et al.

Researchers conducted a retrospective study to assess the safety and efficacy of periprocedural uninterrupted administration of direct oral anticoagulants (DOAC) compared to continuous phenprocoumon among patients with chronic kidney disease (CKD) undergoing left atrial catheter ablation.

They focused on patients with underlying CKD and a glomerular filtration rate (GFR) (2016 to 2019) between 15 and 45 ml/min who underwent left atrial catheter ablation. The goal was to determine whether DOAC therapy or warfarin demonstrated a superior safety profile in these patients. The comparison involved assessing periprocedural complications (arteriovenous (AV) fistula, aneurysm, significant hematoma (>5 cm)) and bleeding events (drop in hemoglobin of >2 g/dl, pericardial effusion, retroperitoneal bleeding, another bleeding, stroke) among those on uninterrupted DOAC or warfarin therapy. The analysis encompassed examining patient baseline characteristics and procedural data.

The result showed that 188 patients were enrolled, with 108 (57%) female, and the mean age was 75.3 ± 8.1 years. The mean GFR was 36.8 ± 6 ml/min. The arrhythmias identified were atrial fibrillation in 104 patients (55.3%) and atypical atrial flutter in 84 (44.7%). Among these patients, 132 (70%) were prescribed DOAC medication, while 56 (30%) were on phenprocoumon. Major groin complications, including pseudoaneurysm and AV fistula, occurred in 8.9% of patients in the phenprocoumon group compared to 11.3% in the DOAC group, and this difference was not statistically significant (P=0.62). The incidence of cardiac tamponade was 2.3% in the phenprocoumon group versus 0% in the DOAC group (P=0.55), and there were no recorded cases of stroke in either group. Post-procedural drops in hemoglobin levels were similar between the DOAC and phenprocoumon groups (1.1 ± 1 g/dl vs. 1.1 ± 0.9 g/dl; P=0.71).

Investigators concluded that uninterrupted DOAC/phenprocoumon for atrial ablation in CKD patients proved safe and effective, with no difference in bleeding/thromboembolic events but slightly higher groin complications.

Source: link.springer.com/article/10.1007/s00392-024-02374-w