John de Heide

DOACs in AF ablation 41 (types 2, 3a, 3b, 3c, 5), clinically relevant nonmajor bleeding (CRNMB) according to ISTH (19), and any clinically relevant bleeding (BARC types 2 to 5; ISTH major bleeding and CRNMB). BARC type 2 bleeding most closely aligns with the ISTH CRNMB (19). The primary thromboembolic endpoint was a composite of stroke, transient ischemic attack (TIA), or other systemic embolism within 30 days. 2.5 Statistical analysis Continuous parameters are presented as the mean ± SD as they were normally distributed. Categorical data are presented as frequencies and percentages. Comparisons between groups were performed with an independent Student t test, chi-square tests, or Fisher exact test. A P-value < 0.05 was considered statistically significant. Statistical analyses were performed using SPSS software (SPSS, version 21; IBM, Chicago, Illinois). 3. Results A total of 637 patients (mean age 60 ± 9 years, 69% male) were included in the analysis, 520 patients (82%) used uninterrupted VKAs and 117 patients (18%) had a minimally interrupted NOAC strategy. In the NOAC group, the following NOACs were used: dabigatran (n = 68), apixaban (n = 30), rivaroxaban (n = 14), and edoxaban (n = 5). The NOAC group comprised more patients with long-standing persistent AF and a lower proportion of patients with a CHA2DS2-VASc ≥ 2 (Table 1). All other baseline variables were similar between groups. Figure 1 demonstrates the increased use of NOAC over the years in our AF ablation population. 3.1 Bleeding complications The rates of major bleeding, either by BARC or ISTH criteria, were similar between groups (Table 2). The rate of any clinically relevant bleeding (BARC types 2–5; composite of ISTH major bleeding and CRNMB) was lower with NOACs compared with VKAs. This difference was mainly due to a difference in clinically relevant nonmajor bleeding (CRNMB or BARC type 2) (Table 2). No patient in either group had a BARC type 3c (i.e., intracranial bleeding) or type 5 bleeding (i.e., fatal bleeding). Cardiac tamponade occurred in 4 patients (0.8%) of the VKA group and in 1 patient (0.9%) of the NOAC group (P = 1.00). 3

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