To evaluate the factors associated with bleeding complications in patients taking apixaban and undergoing a rhythmology procedure in everyday clinical practice.

AMPER AF is a multicenter, observational, prospective study of patients with non-valvular atrial fibrillation (AF) undergoing a rhythmology procedure (ablation, pacemaker or implantable cardioverter defibrillator [ICD], or cardioversion). Eligible patients had been taking apixaban (2.5 or 5mg twice daily) for ≥3 weeks before the procedure, and were followed for 30 days afterwards.

A total of 1013 patients (69 [60,76] years,71% male, mean CHA2DS2-VASc score 1.9±1.4) were enrolled at 25 academic/non-academic centres in France; 842 patients (84.8%) were receiving apixaban 10mg/day and 171 (15.2%) 5mg/day.56 patients (5.5%) had a history of stroke. Median weight was 82.7±17.9kg and mean creatinine clearance (Cockroft−Gault) was 81.8±34mL/min. 126 (12.43%) patients underwent a pacemaker or ICD implantation, 323 (31.9%) AF ablation, 272 (26.8%) flutter ablation and 278 (27.4%) electric cardioversion. Complication rates at 30 days are shown in Table 1. Comparing patients with a bleeding event to patients without a bleeding complication revealed a higher rate of heparin or LMWH switching (3.7% vs. 2.2%; P=0.02) in patients having a bleeding complication in patients undergoing an AF or atrial flutter ablation. This difference remains significant in patients undergoing AF and atrial flutter ablation (60% vs. 35%; P=0.02). A switch to heparin or LMWH was the only factor associated with an increase rate of bleeding (odds ratio 2.5; [CI 95%; 1.1], 7.1; P=0.01).

These observational data of patients on apixaban undergoing rhythmology procedures in everyday practice show thatheparin or LMWH switch in the periprocedural AF or flutter ablation period is associated with an increased rate of bleeding complications at 30 days.