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Master Thesis

Safety of uninterrupted direct oral anticoagulant versus uninterrupted vitamin-K antagonist for ambulatory atrial flutter catheter ablation: a propensity score-matched cohort study

Abstract : Aims. Same-day home discharge after common atrial flutter (CAF) catheter ablation is a feasible, safe and cost-effective practice, but there is currently no data concerning patients treated by uninterrupted direct oral anticoagulant (DOA). We evaluated safety and feasibility of ambulatory CAF catheter ablation in patients treated by DOA compared with vitamin-K antagonist (VKA). Methods and results. Patients scheduled for isolated ambulatory CAF catheter ablation to our tertiary university center between 2009 and 2019 were included. Propensity score for anticoagulant type was calculated from age, gender, body mass index, baseline characteristics and risk factors (included in HAS-BLED and CHA2DS2-VASc scores), chronic kidney disease, associated antiplatelet treatment, procedure duration and number of femoral venipunctures. Propensity score matching yielded 820 patients (age 67 ± 11 years). Catheter ablation was performed under uninterrupted VKA (n=410; INR = 2.5 ± 0.6) or uninterrupted DOA (n=410). Occurrence of the primary safety outcome, defined as any early and clinically significant bleeding (BARC ≥ 2) at one-week, was similar between DOA and VKA patients (2.9 vs 3.7%; p = 0.70), as well as the rate of effective same-day discharge (94.9 vs 92.2%; p = 0.15). Female gender, high HAS-BLED score and prolonged procedure duration were risk factors for bleeding at one-week. Conclusion. Uninterrupted DOA regimen is safe for selected patients undergoing ambulatory CAF catheter ablation, in a high-volume center with a dedicated ambulatory unit and a standardized procedural and postoperative management.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-02465661
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Submitted on : Tuesday, February 4, 2020 - 8:59:15 AM
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  • HAL Id : dumas-02465661, version 1

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Patrick Bittar. Safety of uninterrupted direct oral anticoagulant versus uninterrupted vitamin-K antagonist for ambulatory atrial flutter catheter ablation: a propensity score-matched cohort study. Human health and pathology. 2019. ⟨dumas-02465661⟩

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