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Mukai Y, Wada K, Miyamoto K, et al. The influence of residual apixaban on bleeding complications during and after catheter ablation of atrial fibrillation. J Arrhythm. 2017;33(5):434-439doi: 10.1016/j.joa.2017.06.005.
Mukai, Y., Wada, K., Miyamoto, K., Nakagita, K., Fujimoto, M., Hosomi, K., Kuwahara, T., Takada, M., Kusano, K., & Oita, A. (2017). The influence of residual apixaban on bleeding complications during and after catheter ablation of atrial fibrillation. Journal of arrhythmia, 33(5), 434-439. https://doi.org/10.1016/j.joa.2017.06.005
Mukai, Yutaro, et al. "The influence of residual apixaban on bleeding complications during and after catheter ablation of atrial fibrillation." Journal of arrhythmia vol. 33,5 (2017): 434-439. doi: https://doi.org/10.1016/j.joa.2017.06.005
Mukai Y, Wada K, Miyamoto K, Nakagita K, Fujimoto M, Hosomi K, Kuwahara T, Takada M, Kusano K, Oita A. The influence of residual apixaban on bleeding complications during and after catheter ablation of atrial fibrillation. J Arrhythm. 2017 Oct;33(5):434-439. doi: 10.1016/j.joa.2017.06.005. Epub 2017 Jul 28. PMID: 29021846; PMCID: PMC5634723.
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J Arrhythm. 2017 Oct;33(5):434-439. doi: 10.1016/j.joa.2017.06.005. Epub 2017 Jul 28.

The influence of residual apixaban on bleeding complications during and after catheter ablation of atrial fibrillation.

Journal of arrhythmia

Yutaro Mukai, Kyoichi Wada, Koji Miyamoto, Kazuki Nakagita, Mai Fujimoto, Kouichi Hosomi, Takeshi Kuwahara, Mitsutaka Takada, Kengo Kusano, Akira Oita

Affiliations

  1. Department of Pharmacy, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
  2. Division of Cardiovascular Drugs, Therapy, Kindai University Graduate School of Pharmacy, Higashi-osaka, Japan.
  3. Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
  4. Division of Clinical Drug Informatics, Kindai University School of Pharmacy, Higashi-osaka, Japan.
  5. Department of Pharmacy, National Center for Global Health and Medicine, Tokyo, Japan.

PMID: 29021846 PMCID: PMC5634723 DOI: 10.1016/j.joa.2017.06.005

Abstract

BACKGROUND: The periprocedural protocol for atrial fibrillation (AF) ablation commonly includes anticoagulation therapy. Apixaban, a direct oral anticoagulant, is currently approved for clinical use; however, little is known about the effects of residual apixaban concentration on bleeding complications during/after AF ablation. Therefore, we measured residual apixaban concentration by using mass spectrometry and examined the anticoagulant's residual effects on bleeding complications.

METHODS: Fifty-eight patients (Mean age of 64.7±12.5 years; 31 males, 27 females) were enrolled and administered apixaban twice daily. We analyzed trough apixaban concentration, activated clotting time (ACT), heparin dose, and bleeding complications during/after AF ablation. Apixaban concentrations were directly measured using mass spectrometry.

RESULTS: Bleeding complications were observed in 19 patients (delayed hemostasis at the puncture site, 16; hematuria, 3; hemosputum, 1). No patient required blood transfusion. The mean trough apixaban concentration was significantly lower in patients with bleeding complications than without (152.4±73.1 vs. 206.8±98.8 ng/mL respectively,

CONCLUSIONS: Low residual plasma apixaban is associated with a higher incidence of bleeding complications during/after AF ablation, potentially because of a greater heparin requirement during AF ablation.

Keywords: Anticoagulation; Apixaban; Atrial fibrillation; Bleeding complication; Catheter ablation

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