Cardiologia Hungarica (Apr 2024)
10 years trends in use of oral anticoagulants in patients undergoing catheter ablation for atrial fibrillation
Abstract
Background: Pulmonary vein isolation (PVI) for atrial fibrillation (AF) is associated with an increased risk of thromboembolism. The appearance of direct oral anticoagulants (DOACs) has significantly altered the recommendations for perioperative anticoagulation. In our study, we analyzed the current trends in anticoagulant choice among patients referred for catheter ablation. Methods: Data from consecutive patients undergoing catheter ablation for AF at our center in 2010, 2015, and 2020 were analyzed. In addition to patient demographics, thromboembolic and bleeding risk factors and information on anticoagulation therapy were collected and compared. Results: In 2010 55, in 2015 146, and in 2020 166 patients were admitted for catheter ablation of AF (mean age 62±11 years; male 54.7%). The mean age of patients undergoing ablation increased significantly in 2015 compared to 2010, but thereafter did not change. Both the CHA2DS2-VA score calculated without sex category (1.6±1.3 ® 2.3±1.3 ® 2.6±1.5) and the HAS-BLED score (0.53±0.7 ® 0.77±0.8 ® 1.06±1.0) increased continuously with the time. At admission in 2010, 78.2% of patients were taking vitamin K antagonist (VKA), 5.5% were on LMWH and 16,4% were not anticoagulated. In 2015, the VKA rate decreased to 66.4%, 24.7% had DOACs, 3.4% were still on LMWH and 5,5% were still not treated. By 2020, DOACs became the leading anticoagulants with 65.1%, VKAs decreased to 28.9%, LMWH was prescribed in 1.2%, and in 4.8% patients were referred without anticoagulation. Conclusion: Although the DOACs have become the first-line therapy in the last 10 years in patients undergoing catheter ablation at our clinic, nearly one third of patients still received VKA treatment in 2020. A continuous trend for increasing thromboembolic and bleeding risk indicates the expansion of the indication for PVI.
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