Patients
This is a retrospective and multicenter study of the impact of 4 different minimally interrupted DOACs on the intraprocedural anticoagulation and post-procedural hemoglobin drop following AF ablation. The databases of AF ablation were reviewed in Onomichi General Hospital, Hiroshima General Hospital, and Hiroshima University Hospital. The data from January 2016 to December 2019 were collected. The study protocol was approved by the research committee of each institution. Consecutive patients with AF were considered eligible for inclusion if they underwent a radiofrequency-based pulmonary vein isolation for the first time, and skipped a single dose of apixaban, dabigatran, edoxaban, or rivaroxaban, prior to the ablation procedures. Patients were excluded if they were prescribed with inappropriate DOAC dose regimens, underwent their ablation procedures in the afternoon, or adjunctive ablation procedures such as cavotricuspid isthmus ablation, linear lesions, superior vena cava isolation, or ablation of non-pulmonary vein triggers. Patients who were older than 65 years old were also excluded since a choice of the DOAC was likely to be biased in an elderly population due to safety concerns [6,7].
Blood samples were collected the day before and 24 hours after the ablation in each patient. A complete blood cell count, coagulation markers, and serum chemistry were measured. For risk stratification of thromboembolisms and bleeding, the CHA2DS2-VASc [8] and ORBID [9] scores were calculated in all patients.