Peri-procedural Oral Anticoagulation
All patients were treated with NOACs or VKA for ≥4 weeks before AF
ablation (dabigatran 150 mg/110 mg b.i.d., rivaroxaban 15 mg/10 mg q.d.,
apixaban 5 mg/2.5 mg b.i.d., edoxaban 60 mg/30 mg q.d., warfarin q.d.).
Approved dose criteria were specific to each NOAC according to the
patient’s renal function, weight, age, and concomitant medications, as
indicated in approved package inserts (PIs).6,7 In
patients on VKA, a target international normalized ratio (INR) was set
to 2.0-3.0 but the therapeutic intensity was lowered (PT-INR 1.6-2.6) in
elderly patients (≥70 years).8 The quality of VKA
control was evaluated by monitoring the PT-INR and calculating the time
in therapeutic range (TTR).9 In all patients, the
initial choice/dose of anticoagulants was decided by the
physicians/cardiologists who first diagnosed AF; the anticoagulants were
continued before ablation without change, interruption, and heparin
bridging. NOACs and VKA were used without interruption during the
procedure. Once-daily drugs (rivaroxaban and edoxaban) were administered
in the morning and the catheter ablation was scheduled in the afternoon.
Inappropriate dose reduction was defined as the low dose treatment due
to physician’s decision/preference that did not follow the PIs in each
drug. A proton pump inhibitor was prescribed in all patients to minimize
the risk of esophageal injury.