AF ablation during therapeutic warfarin levels

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AF ablation during therapeutic warfarin levels: Conventionally, invasive procedures are undertaken by switching over from warfarin to unfractionated heparin to have a better control over bleeding. Santangeli P and associates [Ablation of Atrial Fibrillation under Therapeutic Warfarin Reduces Periprocedural Complications: Evidence from a Meta-Analysis. Circ Arrhythm Electrophysiol. 2012;5:302-11] have conducted a meta analysis of published data on the utility of proceeding with atrial fibrillation (AF) ablation while on therapeutic anticoagulation with warfarin. This was prompted by data from observational studies which had suggested that procedures under continuous warfarin usage may reduce the risk of periprocedural complications like thromboembolic events compared to the discontinuation of warfarin and bridging with heparin. They could identify nine studies with a total of over twenty seven thousand patients in which six thousand and four hundred had undergone AF ablation with continuous warfarin regimen. Continuous warfarin usage was associated with a significant decrease in thromboembolic complications (odds ratio = 0.10, P < 0.001) and minor bleeding complications (odds ratio = 0.38, P = 0.002) as compared to discontinuation of warfarin and bridging with heparin. This would call for a large randomized controlled trial to evaluate this concept further.

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