Feasibility and Safety of Dabigatran Versus Warfarin for Periprocedural Anticoagulation in Patients Undergoing Radiofrequency Ablation for Atrial Fibrillation: Results From a Multicenter Prospective Registry

Feb 01, 2012
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Authors:
Lakkireddy D, Reddy YM, Di Biase L, et al.
Citation:
J Am Coll Cardiol 2012;Feb 1:[Epub ahead of print].
Summary By:
Fred Morady, MD, FACC

Study Questions:

Is dabigatran safe in patients undergoing radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF)?

Methods:

In this observational study, 145 patients (mean age 60 years) underwent RFCA of AF and were anticoagulated with dabigatran, 150 mg twice daily. Dabigatran was withheld the morning of the procedure and restarted 3 hours post-hemostasis. A matched group of patients underwent RFCA during uninterrupted warfarin therapy with an international normalized ratio of 2.0-3.5 (n = 145). Transesophageal echocardiography was performed pre-ablation only in the dabigatran group. Heparin was administered during RFCA to maintain an activated clotting time of 300-400 seconds in all patients. Major bleeds were defined as cardiac tamponade or bleeding requiring blood transfusion or surgical intervention. The primary outcome was a composite of bleeding and thromboembolic complications.

Results:

The rates of all bleeds and major bleeds were significantly higher in the dabigatran group (14% and 6%, respectively) than in the warfarin group (6% and 1%, respectively). The composite outcome also was significantly more prevalent in the dabigatran group (16%) than in the warfarin group (6%). The independent predictors of the composite endpoint were dabigatran use (odds ratio [OR] 2.8) and age >75 years (OR 3.8).

Conclusions:

The risk of bleeding and thromboembolic complications is higher with dabigatran than uninterrupted warfarin in patients undergoing RFCA of AF.

Perspective:

The results indicate that RFCA of AF should not be performed when dabigatran is withheld <24 hours pre-procedure. The half-life of dabigatran is 14-17 hours. It is likely that withholding dabigatran 24-48 hours pre-procedure reduces the risk of bleeding complications, but this issue requires further investigation.

Keywords: Warfarin, Heparin, Hemostasis, Blood Transfusion, Benzimidazoles, Cardiology, Blood Coagulation Tests, Catheter Ablation, Hemorrhage, Echocardiography, Cardiac Tamponade


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