Prevention of Periprocedural Stroke and Management of Hemorrhagic Complication in Atrial Fibrillation Ablation under Continuing Warfarin Administration

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Background: This study aimed to determine the effect of continuing warfarin during periprocedural period of atrial fibrillation (AF) ablation on the prevention of stroke complication and to show a management of hemorrhagic complication in this approach. Method: A total of 2976 patients undergoing AF ablation (3855 sessions) were divided into two groups: the first 1953 patients (2566 sessions) discontinuing warfarin before AF ablation, given heparin and resuming warfarin after the ablation (discontinuing group) and the last 1023 patients (1289 sessions) continuing warfarin throughout the periprocedural period (continuing group). Results: Symptomatic stroke or transient ischemic attack occurred in 13/2566 sessions (0.51%) in the discontinuing group and in 2/1289 sessions (0.16%) in the continuing group. Two stoke patients in the latter group showed insufficient international normalized ratio (INR) of 1.23 and 1.57 before AF ablation. Major hemorrhagic complication occurred in 26/2566 (1%) in the discontinuing group and in 9/1289 (0.7%, 9 cardiac tamponade) in the continuing group. Eight of the 9 patients with cardiac tamponade in the latter group were given prothrombin complex concentrate (PCC) and vitamin K, with the INR corrected and bleeding of cardiac tamponade safely terminated. Conclusion: AF ablation without discontinuation of warfarin was effective to prevent periprocedural stroke complication. Bleeding of cardiac tamponade in this approach was safely terminated with the use of PCC and vitamin K.

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