Peri-procedural anticoagulation in patients with end-stage kidney disease undergoing atrial fibrillation ablation: results from the multicentre end-stage kidney disease-atrial fibrillation ablation registry

被引:4
作者
Yamamoto, Tasuku [1 ]
Miyazaki, Shinsuke [1 ]
Tanaka, Yasuaki [2 ]
Kono, Toshikazu [3 ]
Nakata, Tadanori [4 ]
Mizukami, Akira [5 ]
Aoyama, Daisetsu [6 ]
Arai, Hirofumi [7 ]
Taomoto, Yuta [8 ]
Horie, Tomoki [8 ]
Hojo, Rintaro [9 ]
Kawamoto, Shiho [10 ]
Yabe, Kento [11 ]
Akiyoshi, Kikou [12 ]
Kato, Nobutaka [12 ]
Ono, Yuichi [11 ]
Suzuki, Atsushi [10 ]
Fukamizu, Seiji [9 ]
Nagata, Yasutoshi [8 ]
Yamauchi, Yasuteru [7 ]
Tada, Hiroshi [6 ]
Hachiya, Hitoshi [4 ]
Inaba, Osamu [3 ]
Takahashi, Atsushi [2 ]
Goya, Masahiko [1 ]
Sasano, Tetsuo [1 ]
机构
[1] Tokyo Med & Dent Univ, Dept Cardiovasc Med, Yushima 1-5-45,Bunkyo Ku, Tokyo 1138510, Japan
[2] Yokosuka Kyosai Hosp, Dept Cardiol, Yonegahama Dori 1-16, Yokosuka, Kanagawa 2388558, Japan
[3] Japanese Red Cross Saitama Hosp, Dept Cardiol, Shintoshin 1-5,Chuo Ku, Saitama, Saitama 3308553, Japan
[4] Tsuchiura Kyodo Gen Hosp, Cardiovasc Div, Otsuno 4-1-1, Tsuchiura, Ibaraki 3000028, Japan
[5] Kameda Med Ctr, Dept Cardiol, Higashicho 929, Kamogawa, Chiba 2968602, Japan
[6] Univ Fukui Hosp, Dept Cardiol, Shimoaizuki 2303, Eiheiji, Fukui 9101193, Japan
[7] Japanese Red Cross Yokohama City Bay Hosp, Dept Cardiol, Shinyamashita 3-12-1,Naka Ku, Yokohama, Kanagawa 2318682, Japan
[8] Musashino Red Cross Hosp, Dept Cardiol, Sakaiminami Cho 1-26-1, Musashino, Tokyo 1808610, Japan
[9] Tokyo Metropolitan Hiroo Gen Hosp, Dept Cardiol, Ebisu 2-34-10,Shibuya Ku, Tokyo 1500013, Japan
[10] Tokyo Yamate Med Ctr, Heart Ctr, Hyakunin Cho 3-22-1,Shinjuku Ku, Tokyo 1690073, Japan
[11] Ome Municipal Gen Hosp, Dept Cardiol, Higashiome 4-16-5, Ome 1980042, Japan
[12] Hiratsuka Kyosai Hosp, Dept Cardiol, Higashiome 4-16-5, Ome 1980042, Japan
来源
EUROPACE | 2023年 / 25卷 / 04期
关键词
Atrial fibrillation; End-stage kidney disease; Haemodialysis; Ablation; Anticoagulation; CATHETER ABLATION; HEMODIALYSIS; MANAGEMENT; RISK; OUTCOMES; STROKE; COMPLICATIONS; WARFARIN; DIALYSIS;
D O I
10.1093/europace/euad056
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Aims The optimal anticoagulation regimen in patients with end-stage kidney disease (ESKD) undergoing atrial fibrillation (AF) catheter ablation is unknown. We sought to describe the real-world practice of peri-procedural anticoagulation management in patients with ESKD undergoing AF ablation. Methods and results Patients with ESKD on haemodialysis undergoing catheter ablation for AF in 12 referral centres in Japan were included. The international normalized ratio (INR) before and 1 and 3 months after ablation was collected. Peri-procedural major haemorrhagic events as defined by the International Society on Thrombosis and Haemostasis, as well as thromboembolic events, were adjudicated. A total of 347 procedures in 307 patients (67 +/- 9 years, 40% female) were included. Overall, INR values were grossly subtherapeutic [1.58 (interquartile range: 1.20-2.00) before ablation, 1.54 (1.22-2.02) at 1 month, and 1.22 (1.01-1.71) at 3 months]. Thirty-five patients (10%) suffered major complications, the majority of which was major bleeding (19 patients; 5.4%), including 11 cardiac tamponade (3.2%). There were two peri-procedural deaths (0.6%), both related to bleeding events. A pre-procedural INR value of 2.0 or higher was the only independent predictor of major bleeding [odds ratio, 3.3 (1.2-8.7), P = 0.018]. No cerebral or systemic thromboembolism occurred. Conclusion Despite most patients with ESKD undergoing AF ablation showing undertreatment with warfarin, major bleeding events are common while thromboembolic events are rare.
引用
收藏
页码:1400 / 1407
页数:8
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