RESEARCH HIGHLIGHTS Nature Reviews Cardiology 11, 313 (2014); published online 6 May 2014; doi:10.1038/nrcardio.2014.66


Anticoagulation during AF ablation In patients undergoing radiofrequency catheter ablation for atrial fibrillation (AF), continuous anticoagulation with warfarin reduces the risk of periprocedural thromboembolism and haemorrhage, compared with a strategy of warfarin discontinuation and bridging with low-molecular-weight heparin (LMWH). These findings come from the COMPARE trial. Anecdotal evidence from clinical experience and nonrandomized studies has suggested that the strategy of stopping warfarin therapy and switching to LMWH during catheter ablation for AF is suboptimal, but a randomized clinical trial had not been performed. Therefore, investigators designed the prospective, randomized, parallel-group, open-label, multicentre COMPARE trial. A total of 1,584 patients with AF (429 paroxysmal, 363 persistent, and 792 longstanding persistent) and a CHADS2 score ≥1 were included in the trial. Patients were randomly allocated either to discontinue warfarin therapy 2–3 days before the ablation and bridge with LMWH (n = 790), or to continue warfarin therapy (n = 794). In the latter group, patients had to have an international normalized ratio (INR) in the therapeutic range (2–3). The primary end point of thromboembolic events was defined as the combination of stroke, transient ischaemic attack, or systemic thromboembolism, and occurred in 4.9% of the LMWH group and 0.25% of the uninterrupted warfarin group (P 

Interventional cardiology: Anticoagulation during AF ablation.

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