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  • Bleeding complications...

Bleeding complications common in ESKD patients undergoing atrial fibrillation ablation

Written By : Dr Kartikeya Kohli |Medically Reviewed By : Dr. Kamal Kant Kohli Published On 2023-03-30T19:45:37+05:30  |  Updated On 16 Oct 2023 4:33 PM IST
Bleeding complications common in ESKD patients undergoing atrial fibrillation ablation
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Japan: A recent study suggests that international guideline recommendations for peri-procedural anticoagulation may not apply to end-stage kidney disease (ESKD) patients undergoing atrial fibrillation (AF) catheter ablation and calls for question anticoagulation's role in this population.

In a real-world setting, ESKD patients undergoing AF ablation are grossly underrated from the outlook of anticoagulation guideline recommendations, with 94% of patients having a subtherapeutic international normalized ratio (INR) at some point during the peri-procedural period.

The investigators wrote, "despite most patients with ESKD undergoing AF ablation showing undertreatment with warfarin, thromboembolic events are rare, but major bleeding events are common." The study was published in EP Europace on 09 March 2023.

According to the current peri-procedural anticoagulation guidelines, patients undergoing atrial fibrillation ablation should be under therapeutic anticoagulation throughout the peri-procedural period.

Chronic kidney disease and atrial fibrillation coexist, and many studies have revealed causal links between the two conditions. About 10–20% of patients with end-stage kidney disease are reported to have AF. The use of catheter ablation is growing in this population as many antiarrhythmic drugs undergo renal excretion or metabolism. It is widely accepted that patients undergoing AF ablation be put under therapeutic anticoagulation throughout the peri-procedural period, either with uninterrupted direct oral anticoagulants (DOACs) or continuous warfarin therapy with a target INR of 2.0–3.0.

The optimal anticoagulation regimen in end-stage kidney disease patients undergoing AF catheter ablation is unknown. Tasuku Yamamoto, Tokyo Medical and Dental University, Yushima, Tokyo, Japan, and colleagues sought to describe the real-world practice of peri-procedural anticoagulation management in patients with chronic kidney disease undergoing AF ablation.

The study included ESKD patients on haemodialysis undergoing catheter ablation for AF in Japan's 12 referral centres. 347 procedures were included in 307 patients (67 ±9 years, 40% female). The international normalized ratio was collected 1 and 3 months after ablation. Peri-procedural major haemorrhagic events and thromboembolic events were adjudicated.

The authors reported the following findings:

  • INR values were grossly subtherapeutic [1.58 before ablation, 1.54 at one month, and 1.22 at three months].
  • Thirty-five patients (10%) suffered major complications, the majority of which was major bleeding (19 patients; 5.4%), including 11 cardiac tamponades (3.2%).
  • Two peri-procedural deaths (0.6%) were related to bleeding events.
  • A pre-procedural INR value of 2.0 or higher was the only independent predictor of major bleeding [odds ratio, 3.3].
  • No cerebral or systemic thromboembolism occurred.

The investigators described the real-world practice of peri-procedural anticoagulation in ESKD patients undergoing AF ablation in 12 referral centres in Japan. In a vast majority of patients, INR values were grossly subtherapeutic. Nevertheless, no thromboembolic complications were seen, but haemorrhagic complications were common during the peri-procedural period.

Reference:

Tasuku Yamamoto, Shinsuke Miyazaki, Yasuaki Tanaka, Toshikazu Kono, Tadanori Nakata, Akira Mizukami, Daisetsu Aoyama, Hirofumi Arai, Yuta Taomoto, Tomoki Horie, Rintaro Hojo, Shiho Kawamoto, Kento Yabe, Kikou Akiyoshi, Nobutaka Kato, Yuichi Ono, Atsushi Suzuki, Seiji Fukamizu, Yasutoshi Nagata, Yasuteru Yamauchi, Hiroshi Tada, Hitoshi Hachiya, Osamu Inaba, Atsushi Takahashi, Masahiko Goya, Tetsuo Sasano, Peri-procedural anticoagulation in patients with end-stage kidney disease undergoing atrial fibrillation ablation: results from the multicentre end-stage kidney disease–atrial fibrillation ablation registry, EP Europace, 2023;, euad056, https://doi.org/10.1093/europace/euad056

EP EuropaceAtrial fibrillationatrial fibrillationend-stage kidney diseasechronic kidney diseasehaemodialysisanticoagulationablation
Source : EP Europace
Dr Kartikeya Kohli
Dr Kartikeya Kohli

    Dr Kartikeya Kohli is an Internal Medicine Consultant at Sitaram Bhartia Hospital in Delhi with super speciality training in Nephrology. He has worked with various eminent hospitals like Indraprastha Apollo Hospital, Sir Gangaram Hospital. He holds an MBBS from Kasturba Medical College Manipal, DNB Internal Medicine, Post Graduate Diploma in Clinical Research and Business Development, Fellow DNB Nephrology, MRCP and ECFMG Certification. He has been closely associated with India Medical Association South Delhi Branch and Delhi Medical Association and has been organising continuing medical education programs on their behalf from time to time. Further he has been contributing medical articles for their newsletters as well. He is also associated with electronic media and TV for conduction and presentation of health programs. He has been associated with Medical Dialogues for last 3 years and contributing articles on regular basis.

    Dr. Kamal Kant Kohli
    Dr. Kamal Kant Kohli

    Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751

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