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.