{"id":"b86feafe2d02","type":"article","url":"https://hartvaat.nl/2019/04/01/periprocedurele-antistolling-en-silent-stroke-na-af-ablatie/","title":"Periprocedurele antistolling en silent stroke na AF-ablatie","title_en":"Impact of periprocedural anticoagulation therapy on the incidence of silent stroke after atrial fibrillation ablation in patients receiving direct oral anticoagulants: uninterrupted vs. interrupted by one dose strategy.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":["secundaire-preventie"],"journal":"Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology","doi":"10.1093/europace/euy224","source_url":"https://doi.org/10.1093/europace/euy224","authors":["Tomoyuki Nagao","Hitomi Suzuki","Syun Matsunaga","Yoshinori Nishikawa","Kazuhiro Harada","Kumiko Mamiya","Norihiro Shinoda","Ken Harada","Masataka Kato","Nobuyuki Marui","Tetsuya Amano","Yasuya Inden","Toyoaki Murohara"],"significance":5,"published":"2019-04-01","source_date":"2019-04-01","image":"","kennis":[],"congress":"","summary_en":"This study evaluated the impact of periprocedural anticoagulation strategy (uninterrupted vs interrupted DOAC) on silent stroke incidence after AF ablation, addressing a subtle but clinically relevant safety endpoint.","created":"2026-07-03T10:27:51Z","updated":"2026-07-03T13:27:03Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie naar de impact van periprocedurele antistollingstherapie op de incidentie van silent stroke na AF-ablatie.","abstract_original":"AIMS: Data on the comparison between uninterrupted and interrupted by one dose strategies for direct oral anticoagulant (DOAC) use during the periprocedural period of atrial fibrillation (AF) ablation are scarce. The purpose of this study is to investigate the feasibility of uninterrupted DOAC strategy by evaluating the incidence of silent stroke (SS) and perioperative trends in coagulation markers compared with the interrupted strategy. METHODS AND RESULTS: We randomly divided 200 consecutive patients receiving DOACs, who underwent AF ablation into uninterrupted group (UG = 100) and interrupted by one dose group (IG = 100). The rate of SS confirmed by post-operative magnetic resonance imaging and periprocedural trends in coagulation markers was investigated. A significant difference in SS incidence was found between the UG and IG (UG 4%, IG 17%, P < 0.005), although there were no differences in the rate of complications including bleeding and symptomatic thrombo-embolic events between the two groups. Intraoperative cardioversion [odds ratio (OR) 7.27, 95% confidence interval (CI) 1.76-30.0; P < 0.01] and the length of procedure time (OR 1.03, 95% CI 1.01-1.05; P < 0.05) independently predicted the occurrence of SS in the IG. A significant increase in prothrombin fragment 1 + 2 (PF1 + 2) values was observed in the IG compared with the UG on the operative and first post-operative days. CONCLUSION: Silent stroke incidence in the IG was significantly higher than that in the UG; this seems to be supported by the difference in PF1 + 2 values between the UG and IG. Intraoperative cardioversion and procedure time predicted the occurrence of SS in the IG."}