Bleeding Complications in Patients Undergoing Pulmonary Vein Isolation without Discontinuance of Warfarin

Abstract

Background: Periprocedural anticoagulation with warfarin was reported to reduce the risk of stroke without increasing the risk of bleeding complications for radiofrequency catheter ablation of atrial fibrillation in US population. Methods and Results: The outcome of thromboembolic and hemorrhagic complication was surveyed in 20 consecutive patients who underwent pulmonary vein isolation in our hospital without discontinuance of warfarin. In these patients, the INR was aimed to keep >2.0. After the transseptal puncture, a heparin bolus (2000–5000 U) was administered, followed by additional heparin bolus and infusion to keep the activated clotting time (ACT) >350. As a result, no periprocedural stroke/transient ischemic attack was reported. Bleeding complications that need transfusion and/or prolongation of hospitarization occurred in 3 (15%) patients (1 cardiac tamponade, 1 massive hematoma, and 1 outside bleeding from venous puncture site). In 2 (10%) patients, ACT was inappropriately prolonged (>800) by initial 5000 U of heparin bolus. Conclusion: It is suggested that above mentioned control of periprocedural INR and ACT during procedure may increase hemorrhagic events in Japanese patients who undergo pulmonary vein isolation. In the case whose INR is >2.0, initial heparin bolus may be ristricted <5000 U to avoid inappropriate prolongation of ACT.