Direct Oral Anticoagulants Safer Than Aspirin Following Ventricular Ablation

August 3, 2021
By Louise Gagnon VIRTUAL -- August 2, 2021 -- Data from the STROKE-VT trial showed that a direct oral anticoagulant (DOAC) offers more protection from stroke and transient ischaemic attack than aspirin following left ventricular tachycardia or premature ventricular contraction using radiofrequency ablation, researchers reported at the Virtual 2021 Annual Meeting of the Heart Rhythm Society (HRS). Dhanunjaya R. Lakkireddy, MD, Kansas City Heart Rhythm Institute at HCA Midwest Health, Overland Park, Kansas, and colleagues randomised 246 patients scheduled for ablation at 1 of 4 centres to receive a DOAC or aspirin after the procedure and after 3 hours of haemostasis. Ventricular tachycardia ablation was performed either through the retrograde aortic approach (n = 98) or through the transseptal approach (n = 148). MRI scans were conducted on the brain within 24 hours after the procedure and after 30 days. “We found at the end of the 30-day follow up, that there was a significantly higher risk of stroke and TIA in those patients who were randomised to aspirin,” said Dr. Lakkireddy. He noted that 4.5% of patients who were administered DOACs versus 19.6% of those administered aspirin experienced transient ischaemic attacks, and 0% of those on DOACs versus 7.1% of those on aspirin experienced stroke, with both differences being statistically significant (P P = .03) and at 30 days (18% vs 6.5%; P = .006). “There is a prothrombotic milieu that one has to be worried about.” Rates of complications were similar between the 2 groups. One of the biggest messages from the trial is that DOACs should be used to anticoagulate patients undergoing ablation of the left ventricle to mitigate the risk of thromboembolic events, said Dr. Lakkireddy. “We should try and avoid a retrograde aortic approach if it can be avoided,” he added. “We also need to pay attention to poor ejection fraction.” [Presentation title: Safety And Efficacy of Periprocedural Direct Oral Anticoagulant Versus Aspirin Use for Reduction of the Risk of Cerebrovascular Events in Patients Undergoing Ventricular Tachycardia Radiofrequency Catheter Ablation (STROKE-VT). Abstract B-LBCT01-01]