Title:Are Some Anticoagulants More Equal Than Others? - Evaluating the Role of Novel Oral Anticoagulants in AF Ablation
Volume: 12
Issue: 4
Author(s): Rajiv Sankaranarayanan and David J. Fox
Affiliation:
Keywords:
Atrial fibrillation, anticoagulation, thromboembolism, stroke, bleeding, ablation.
Abstract: Left atrial ablation strategies are being increasingly performed as a
Class 1 therapeutic indication for drug refractory paroxysmal atrial fibrillation
(AF). Traditionally AF ablation has been performed with patients on uninterrupted
warfarin therapy, however over the last few years, novel oral anticoagulants
(NOACs) have emerged as attractive alternatives to warfarin in order to reduce
stroke risk due to AF. NOACs are therefore increasingly being used instead of
warfarin in the management of AF. There is also mounting evidence mainly in the
form of small randomised studies and meta-analysis that have demonstrated that
the use of NOACs for AF ablation is efficacious, safe and convenient. However
the peri-procedural dosing protocols used in various studies especially in terms of
whether NOAC use is interrupted or uninterrupted during AF ablation, have significant inter-operator
and inter-institution variability. Currently there is also a lack of randomised controlled trials to validate
the data obtained from meta-analyses. There is also evidence that use of NOACs may increase
the requirement of unfractionated heparin during the procedure. This review article shall examine the
currently available evidence-base, appraise the gaps in the current evidence and also underscore the
need for larger randomised clinical trials in this rapidly developing field.
