https://orcid.org/0000-0001-7900-7835
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Koshiro Kanaoka, Yoshitaka Iwanaga, Oral anticoagulant use after catheter ablation for atrial fibrillation based on thrombo-embolic risk: future studies will be needed for bleeding high-risk group, European Heart Journal, Volume 45, Issue 32, 21 August 2024, Pages 2997–2998, https://doi.org/10.1093/eurheartj/ehae389
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This commentary refers to ‘Oral anticoagulation after atrial fibrillation catheter ablation: benefits and risks’, by K. Kanaoka et al., https://doi.org/10.1093/eurheartj/ehad798 and the discussion piece ‘What influences the bleeding risk of long-term anticoagulation after catheter ablation in patients with atrial fibrillation at high risk of thromboembolism?’, by L. Lv, https://doi.org/10.1093/eurheartj/ehae388.
We thank Dr Lv for his insightful comments about our manuscript describing the benefits and risks of continuing oral anticoagulant (OAC) therapy after catheter ablation (CA) for atrial fibrillation (AF).
First, Dr Lv commented on the inconsistent result of major bleeding between the CHADS2 score ≥ 3 and CHA2DS2-VASC score ≥ 4 groups. Although the both groups were considered as a high-risk group, the patient number and characteristics cannot be comparable between groups. In this study, the number of patients in the CHADS2 score ≥ 3 group was 20 227 and CHA2DS2-VASC ≥ 4 group was 38 704.1 The distribution based on CHADS2 and CHA2DS2-VASC score in this study was almost consistent with other Japanese registries.2 In this context, patients in the CHA2DS2-VASC ≥ 4 group included a relatively large number of patients from both the CHADS2 ≥ 3 and <3 groups, which may explain a higher bleeding risk when continuing OACs in the CHA2DS2-VASC ≥ 4 group. Although we used the CHADS2 score for the main analysis because the CHADS2 score showed good predictive performance in the Japanese population, the relatively small number of high risk (CHADS2 score ≥ 3) group may cause statistically negative results in the severe bleeding events in the continued OAC group. Thus, as mentioned in the Limitation section of our paper, future randomized controlled studies focusing on patients with higher thrombo-embolic risk patients would clarify these results.
