Uninterrupted Warfarin for Periprocedural Anticoagulation in Catheter Ablation of Typical Atrial Flutter: A Safe and Cost‐Effective Strategy
- 26 January 2010
- journal article
- research article
- Published by Wiley in Journal of Cardiovascular Electrophysiology
- Vol. 21 (2), 150-154
- https://doi.org/10.1111/j.1540-8167.2009.01603.x
Abstract
Many patients undergoing catheter ablation of atrial flutter (AFL) require periprocedural anticoagulation. We compared a strategy of conversion to low molecular weight heparin (LMWH) periprocedure to uninterrupted warfarinization in a nonrandomized, case-controlled study.One hundred and one consecutive patients requiring periprocedural anticoagulation for catheter ablation of typical AFL were studied. The first 51 patients underwent conversion to LMWH (enoxaparin 1 mg/kg bd) with a warfarin pause (LMWH group), the subsequent 50 continued with uninterrupted oral anticoagulation (Warfarin group). Primary endpoint was a composite of major and minor bleeding complications and groin symptoms.Fewer patients in the Warfarin group reached the primary endpoint (36.0% vs 56.8%, P = 0.013). Four patients in the LMWH group but no patient in the Warfarin group required hospital admission for bleeding-related complications. Cost analysis showed mean cost per patient of anticoagulation with LMWH to be pounds sterling 100.9 (95% CI 94.46-107.30) compared to pounds sterling 10.23 (4.49-15.97) in the Warfarin group (P < 0.0001). Transesophageal echocardiography (TEE) was performed prior to ablation in 11 patients in the Warfarin group and in 3 patients in the LMWH (P = 0.019). When TEE costs were included, costs were pounds sterling 125.00 ($188.25) (96.80-153.60) for the LMWH strategy and pounds sterling 108.5 ($163.40) (54.92-162.1) for the Warfarin group (P < 0.0001).Catheter ablation of typical AFL without interruption of warfarin appears safer and more cost-effective than periprocedural conversion to LMWH. It could be used as a routine anticoagulation strategy for the ablation of right-sided arrhythmias.Keywords
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