Chapter 3 42 3.2 Thromboembolic complications There were no differences in the systemic thromboembolic event rates between both groups (0.6% versus 0%, P = 1.00) (Table 2). In the VKA group, 1 patient (0.2%) experienced a vertebrobasilar stroke 3 days after the procedure. Three months after the procedure, this patient had a modified Rankin score of 1. Furthermore, 2 patients (0.4%) in the VKA group experienced a TIA 1 day after the procedure. They had an uneventful recovery. No patient in the NOAC group experienced a systemic thromboembolic event. No deaths occurred. 4. Discussion The main findings of our study are that (1) the rate of clinically relevant non-major bleeding was lower in patients with a minimally interrupted NOAC strategy compared with those with an uninterrupted VKA strategy, and (2) the rates of major bleeding and thromboembolic events were similar between groups. Uninterrupted use of vitamin K antagonists (VKA) as periprocedural anticoagulant is currently widely accepted for patients undergoing catheter ablation of AF who are using VKA. However, there is an increased use of NOACs in the current AF ablation population. Despite initial concerns on the safety of using periprocedural NOAC (20), nowadays, several large RCTs have demonstrated the safety and efficacy of uninterrupted use of NOACs (i.e., dabigatran, rivaroxaban, apixaban) during AF ablation (5, 6, 12) (Table 3). In clinical practice, however, most centers still use a minimally interrupted NOAC strategy (16). The European Snapshot Survey on Procedural Routines in Atrial Fibrillation Ablation (ESS-PRAFA) in 2015 demonstrated that AF ablations were performed with a minimally interrupted NOAC strategy (1–2 doses withheld) in 53% of procedures, interrupted NOAC ≥2 days in 34%, and an uninterrupted NOAC strategy in 14% (16). The Ablation peRIoperative DabiGatran in use Envisioning in Japan (ABRIDGE-J) randomized trial demonstrated that anticoagulation with minimally interrupted dabigatran (1 or 2 doses withheld) was associated with fewer ISTH major bleeding complications than uninterrupted VKA with no increase in thromboembolic events (Table 3) (13). In addition, the Apixaban Evaluation of Interrupted Or Uninterrupted anticoagulation for ablation of atrial fibrillation (AEIOU)
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