Introduction
Anticoagulation with direct oral anticoagulants (DOACs) is a corner
stone of the periprocedural period of atrial fibrillation (AF) ablation
[1]. An uninterrupted DOAC strategy has recently become increasingly
common in response to the results of landmark trials [2,3].
Nevertheless, a minimally interrupted DOAC approach still seems to
remain a mainstream strategy since a specific antidote for each DOAC is
not necessarily available, thus far [1]. Even with a DOAC’s short
half-live, its unignorable residual activity remains during the ablation
procedure with this anticoagulation approach [4,5]. Its clinical
significance, therefore, may be of interest.
An increasing concern about the procedural safety and operator’s
dedicated efforts have reduced thromboembolic and hemorrhagic
complications during AF ablation, consequently making it difficult to
find out any difference in their frequency across the different DOACs
[1]. Given that the activated clotting time (ACT) reflects the
coagulable state in each subject, and therefore, its measurement is
mandatory during the ablation [1], it could be worth comparing
across the different DOACs instead of thromboembolic events. Unlike
major bleeding complications, a significant hemoglobin drop without any
overt bleeding is often encountered during the early post-AF ablation
period. We thus turned our attention to it as an alternative endpoint to
bleeding complications.
The goal of the present study was to test if there was any difference in
the parameters regarding intraablation anticoagulation and a
post-procedural hemoglobin drop across 4 commercially available DOACs
among subjects undergoing AF ablation with a minimally interrupted DOAC
approach.