Current Status and Clinical Outcomes of Oral Anticoagulant Discontinuation After Ablation for Atrial Fibrillation in Japan ― Findings From the AF Frontier Ablation Registry

Background:The safety of discontinuing oral anticoagulant (OAC) after ablation for atrial fibrillation (AF) in Japanese patients has not been clarified.Methods and Results:A study based on the Atrial Fibrillation registry to Follow the long-teRm Outcomes and use of aNTIcoagulants aftER Ablation (AF...

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Veröffentlicht in:Circulation Journal 2019/11/25, Vol.83(12), pp.2418-2427
Hauptverfasser: Okumura, Yasuo, Nagashima, Koichi, Arai, Masaru, Watanabe, Ryuta, Yokoyama, Katsuaki, Matsumoto, Naoya, Otsuka, Takayuki, Suzuki, Shinya, Hirata, Akio, Murakami, Masato, Takami, Mitsuru, Kimura, Masaomi, Fukaya, Hidehira, Nakahara, Shiro, Kato, Takeshi, Shimizu, Wataru, Iwasaki, Yu-ki, Hayashi, Hiroshi, Harada, Tomoo, Nakajima, Ikutaro, Okumura, Ken, Koyama, Junjiroh, Tokuda, Michifumi, Yamane, Teiichi, Momiyama, Yukihiko, Tanimoto, Kojiro, Soejima, Kyoko, Nonoguchi, Noriko, Ejima, Koichiro, Hagiwara, Nobuhisa, Harada, Masahide, Sonoda, Kazumasa, Inoue, Masaru, Kumagai, Koji, Hayashi, Hidemori, Satomi, Kazuhiro, Yazaki, Yoshinao, Watari, Yuji, on behalf of the AF Ablation Frontier Registry
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Zusammenfassung:Background:The safety of discontinuing oral anticoagulant (OAC) after ablation for atrial fibrillation (AF) in Japanese patients has not been clarified.Methods and Results:A study based on the Atrial Fibrillation registry to Follow the long-teRm Outcomes and use of aNTIcoagulants aftER Ablation (AF Frontier Ablation Registry) was conducted. Data were collected from 3,451 consecutive patients (74.1% men; age, 63.3±10.3 years) who had undergone AF ablation at any of 24 cardiovascular centers in Japan between August 2011 and July 2017. During a 20.7-month follow-up period, OAC therapy was discontinued in 1,836 (53.2%) patients; 51 patients (1.5%) suffered a stroke/transient ischemic attack (TIA), 71 (2.1%) suffered major bleeding, and 36 (1.0%) died. Patients in whom OAC therapy was discontinued were significantly younger than those in whom OACs were continued, and their CHA2DS2-VASc scores were significantly lower. The incidences of stroke/TIA, major bleeding, and death were significantly lower among these patients. Upon multivariate adjustment, stroke events were independently associated with relatively high baseline CHA2DS2-VASc scores but not with OAC status.Conclusions:Although the incidences of stroke/TIA, major bleeding, and death were relatively low among patients for whom OAC therapy was discontinued, stroke/TIA occurrence was strongly associated with a high baseline stroke risk rather than with OAC status. Thus, discontinuation of OAC therapy requires careful consideration, especially in patients with a high baseline stroke risk.
ISSN:1346-9843
1347-4820
1347-4820
DOI:10.1253/circj.CJ-19-0602