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Reply to the Editor—Perioperative anticoagulation management during thoracoscopic ablation
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Reply to the Editor—Perioperative anticoagulation management during thoracoscopic ablation We appreciate the interest that Osmancik et al have expressed regarding our recently published study. We agree that periprocedural anticoagulation is an important and challenging issue. In general, our protocol described below is in keeping with others.1 All patients were treated with warfarin for at least 4 weeks before the procedure, with the target international normalized ratio between 2 and 3. Warfarin was discontinued, and patients were switched to low-molecular-weight heparin 3–5 days before the procedure at a daily dosage of 200 U/kg body weight. Transesophageal echocarcrdiography was performed 24 hours before the thoracoscopic procedure to exclude the presence of thrombus in the left atrial appendage. Low-molecular-weight heparin was held on the day of the procedure. During the procedure, patients were not anticoagulated to minimize bleeding risk. Anticoagulation therapy with low-molecular-weight heparin and warfarin was resumed after thoracoscopic ablation when the patient was admitted to the intensive care unit.
1547-5271/$-see front matter B 2016 Heart Rhythm Society. All rights reserved.
When the international normalized ratio was approximately 2.0, low-molecular-weight heparin was discontinued and therapy with warfarin was continued for a minimum of 3 months. After 3 months of anticoagulation, therapy was administered at the discretion of the treating physician based on risk assessment.2 Alexander Romanov, MD,* [email protected] Evgeny Pokushalov, MD, PhD,* Denis Losik, MD,* Jonathan S. Steinberg, MD† *
State Research Institute of Circulation Pathology Novosibirsk, Russia † University of Rochester School of Medicine & Dentistry New York, New York
References 1. Probst J, Jidéus L, Blomström P, et al. Thoracoscopic epicardial left atrial ablation in symptomatic patients with atrial fibrillation: thoracoscopic epicardial left atrial ablation in symptomatic patients with atrial fibrillation. Europace 2016;18: 1538–1544. 2. Romanov A, Pokushalov E, Elesin D, et al. Effect of left atrial appendage excision on procedure outcome in patients with persistent atrial fibrillation undergoing surgical ablation. Heart Rhythm 2016;13:1803–1809.
http://dx.doi.org/10.1016/j.hrthm.2016.11.030
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Reply to the Editor—Perioperative anticoagulation management during thoracoscopic ablation We appreciate the interest that Osmancik et al have expressed regarding our recently published study. We agree that periprocedural anticoagulation is an important and challenging issue. In general, our protocol described below is in keeping with others.1 All patients were treated with warfarin for at least 4 weeks before the procedure, with the target international normalized ratio between 2 and 3. Warfarin was discontinued, and patients were switched to low-molecular-weight heparin 3–5 days before the procedure at a daily dosage of 200 U/kg body weight. Transesophageal echocarcrdiography was performed 24 hours before the thoracoscopic procedure to exclude the presence of thrombus in the left atrial appendage. Low-molecular-weight heparin was held on the day of the procedure. During the procedure, patients were not anticoagulated to minimize bleeding risk. Anticoagulation therapy with low-molecular-weight heparin and warfarin was resumed after thoracoscopic ablation when the patient was admitted to the intensive care unit.
1547-5271/$-see front matter B 2016 Heart Rhythm Society. All rights reserved.
When the international normalized ratio was approximately 2.0, low-molecular-weight heparin was discontinued and therapy with warfarin was continued for a minimum of 3 months. After 3 months of anticoagulation, therapy was administered at the discretion of the treating physician based on risk assessment.2 Alexander Romanov, MD,* [email protected] Evgeny Pokushalov, MD, PhD,* Denis Losik, MD,* Jonathan S. Steinberg, MD† *
State Research Institute of Circulation Pathology Novosibirsk, Russia † University of Rochester School of Medicine & Dentistry New York, New York
References 1. Probst J, Jidéus L, Blomström P, et al. Thoracoscopic epicardial left atrial ablation in symptomatic patients with atrial fibrillation: thoracoscopic epicardial left atrial ablation in symptomatic patients with atrial fibrillation. Europace 2016;18: 1538–1544. 2. Romanov A, Pokushalov E, Elesin D, et al. Effect of left atrial appendage excision on procedure outcome in patients with persistent atrial fibrillation undergoing surgical ablation. Heart Rhythm 2016;13:1803–1809.
http://dx.doi.org/10.1016/j.hrthm.2016.11.030
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