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Coagulation Response and Prothrombotic Effect of Uninterrupted Oral Anticoagulant Administration After Catheter
Satoshi Yanagisawa1, Yasuya Inden2, Shuro Riku2
1Department of Advanced Cardiovascular Therapeutics, Nagoya University Graduate School of Medicine, Nagoya, Japan; Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Insights
Catheter ablation for ventricular tachycardia (VT) increases prothrombotic risk. Uninterrupted oral anticoagulation (OAC) effectively suppresses this response, potentially reducing perioperative risks in VT ablation patients.
Area of Science:
- Cardiology
- Hematology
- Medical Devices
Background:
- Catheter ablation for ventricular tachycardia (VT) carries a risk of perioperative thromboembolism.
- Optimal postprocedural management strategies for VT ablation patients remain unclear.
Purpose of the Study:
- To assess the prothrombotic response following VT ablation.
- To compare coagulation biomarkers in patients with and without oral anticoagulation (OAC).
Main Methods:
- Retrospective analysis of 112 patients undergoing endocardial VT ablation (58 with uninterrupted OAC, 54 without).
- Included control groups: 41 for premature ventricular contraction ablation, 13 for electrophysiology study.
- Coagulation markers measured pre-procedure and 3 days post-procedure.
Main Results:
- VT ablation activated the coagulation cascade, particularly in the non-OAC group.
- D-dimer levels decreased significantly in the non-OAC VT group post-ablation.
- Oral anticoagulation (OAC) administration and normal baseline coagulation markers predicted stable post-ablation coagulation.
Conclusions:
- Ventricular tachycardia ablation significantly activates the coagulation cascade.
- Uninterrupted OAC administration mitigates the prothrombotic response after VT ablation.
- OAC may reduce perioperative prothrombotic risk in VT ablation patients.
Background:
Catheter ablation for ventricular tachycardia (VT) is associated with perioperative thromboembolic risk. However, the strategy for postprocedural management remains unknown.
Objectives:
The aim of this study was to evaluate the prothrombotic response after VT ablation in various coagulation biomarkers in patients with and without the administration of oral anticoagulation (OAC).
Methods:
Data from 112 patients (58 with uninterrupted OAC and 54 without) with structural heart disease who underwent endocardial VT ablation were retrospectively analyzed. We also included 41 patients who underwent ablation for premature ventricular contraction from the right ventricle and 13 patients who underwent electrophysiology study (the control group). Blood samples of coagulation markers were collected before and 3 days after the procedure in all patients.
Results:
The percentage of D-dimer levels ≤1.0 μg/mL at baseline was lower in the VT ablation groups (76% and 50% in the OAC and non-OAC groups, respectively) than in the other groups (100%). After 3 days, the percentage remained at 67% in the OAC group; however, the non-OAC VT group demonstrated a remarkable decrease of 20%. Similarly, fibrin monomer complex, thrombin antithrombin, and prothrombin fragment 1+2 levels were well suppressed in the control, premature ventricular contraction, and OAC groups. However, the non-OAC group demonstrated increased coagulation markers both before and after 3 days. Multivariate analysis demonstrated that OAC administration and normal coagulation markers at baseline were independent predictors of stable coagulation status after ablation.
Conclusions:
The coagulation cascade was significantly activated in patients undergoing VT ablation. Uninterrupted OAC administration suppressed the coagulation response, which might be associated with a reduction in perioperative prothrombotic risk.
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