Safety and Efficacy of Uninterrupted Direct Oral Anticoagulant Administration in Elderly Patients Undergoing Catheter Ablation of Atrial Fibrillation


In this editorial, the authors discuss the increased risk of thromboembolic events associated with catheter ablation of patients with atrial fibrillation, particularly in older patients aged > 80 years. Data from randomized trials have demonstrated the safety of uninterrupted use of non-vitamin K antagonist oral anticoagulants (NOACs) during catheter ablation but there is a lack of data in elderly patients. The authors refer to an article by Yanagisawa et al in the same issue of JACC: Clinical Electrophysiology, which evaluated the safety and efficacy of uninterrupted NOACs and uninterrupted warfarin in older patients, aged > 75 years.

The mean age of patients was 78 years. There were no significant differences in major bleeding and minor bleeding events between NOAC and warfarin groups. However, bleeding events in older patients were higher compared with younger patients, which suggests that there is an increased risk of bleeding events with advancing age. The editorial concludes that the results reported by Yanagisawa et al are very relevant for current clinical practice and further studies in assessing the reduction in stroke events in this population would be helpful.

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Di Biase L, Romero J. JACC Clin Electrophysiol 2018;4:601–3.