Dabigatran vs warfarin for radiofrequency catheter ablation of atrial fibrillation

Jin-Seok Kim, Fei She, Krit Jongnarangsin, Aman Chugh, Rakesh Latchamsetty, Hamid Ghanbari, Thomas Crawford, Arisara Suwanagool, Mohammed Sinno, Thomas Carrigan, Robert Kennedy, Wouter Saint-Phard, Miki Yokokawa, Eric Good, Frank Bogun, Frank Pelosi, Fred Morady, Hakan Oral

Research output: Contribution to journalArticle

127 Citations (Scopus)

Abstract

Background: It is not clear whether dabigatran is as safe and effective as uninterrupted anticoagulation with warfarin during radiofrequency catheter ablation (RFA) of atrial fibrillation (AF). Objective: To compare the safety and efficacy of dabigatran by using a novel administration protocol and uninterrupted anticoagulation with warfarin for periprocedural anticoagulation in patients undergoing RFA of AF. Methods: In this case-control analysis, 763 consecutive patients (mean age 61±10 years) underwent RFA of AF using dabigatran (N = 191) or uninterrupted warfarin (N = 572) for periprocedural anticoagulation. In all patients, anticoagulation was started≥4 weeks before RFA. Dabigatran was held after the morning dose on the day before the procedure and resumed 4 hours after vascular hemostasis was achieved. Results: A transesophageal echocardiogram performed in all patients receiving dabigatran did not demonstrate an intracardiac thrombus. There were no thromboembolic complications in either group. The prevalence of major (4 of 191, 2.1%) and minor (5 of 191, 2.6%) bleeding complications in the dabigatran group were similar to those in the warfarin group (12 of 572, 2.1%; P = 1.0 and 19 of 572, 3.3%; P =.8, respectively). Pericardial tamponade occurred in 2 of 191 (1%) patients in the dabigatran group and in 7 of 572 (1.2%) patients in the warfarin group (P = 1.0). All patients who had a pericardial tamponade, including 2 in the dabigatran group, had uneventful recovery after perdicardiocentesis. On multivariate analysis, international normalized ratio (odds ratio [OR] 4.0; 95% confidence interval [CI] 1.1-15.0; P =.04), clopidogrel use (OR 4.2; 95% CI 1.5-12.3; P =.01), and CHA2DS2-VASc score (OR 1.4; 95% CI 1.1-1.8; P =.01) were the independent risk factors of bleeding complications only in the warfarin group. Conclusions: When held for approximately 24 hours before the procedure and resumed 4 hours after vascular hemostasis, dabigatran appears to be as safe and effective as uninterrupted warfarin for periprocedural anticoagulation in patients undergoing RFA of AF.

Original languageEnglish
Pages (from-to)483-489
Number of pages7
JournalHeart Rhythm
Volume10
Issue number4
DOIs
Publication statusPublished - 2013 Apr 1
Externally publishedYes

Fingerprint

Catheter Ablation
Warfarin
Atrial Fibrillation
Cardiac Tamponade
clopidogrel
Odds Ratio
Confidence Intervals
Hemostasis
Blood Vessels
Hemorrhage
Dabigatran
International Normalized Ratio
Thrombosis
Multivariate Analysis
Safety

Keywords

  • Atrial fibrillation
  • Bleeding
  • Catheter ablation
  • Dabigatran
  • Warfarin

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Kim, J-S., She, F., Jongnarangsin, K., Chugh, A., Latchamsetty, R., Ghanbari, H., ... Oral, H. (2013). Dabigatran vs warfarin for radiofrequency catheter ablation of atrial fibrillation. Heart Rhythm, 10(4), 483-489. https://doi.org/10.1016/j.hrthm.2012.12.011

Dabigatran vs warfarin for radiofrequency catheter ablation of atrial fibrillation. / Kim, Jin-Seok; She, Fei; Jongnarangsin, Krit; Chugh, Aman; Latchamsetty, Rakesh; Ghanbari, Hamid; Crawford, Thomas; Suwanagool, Arisara; Sinno, Mohammed; Carrigan, Thomas; Kennedy, Robert; Saint-Phard, Wouter; Yokokawa, Miki; Good, Eric; Bogun, Frank; Pelosi, Frank; Morady, Fred; Oral, Hakan.

In: Heart Rhythm, Vol. 10, No. 4, 01.04.2013, p. 483-489.

Research output: Contribution to journalArticle

Kim, J-S, She, F, Jongnarangsin, K, Chugh, A, Latchamsetty, R, Ghanbari, H, Crawford, T, Suwanagool, A, Sinno, M, Carrigan, T, Kennedy, R, Saint-Phard, W, Yokokawa, M, Good, E, Bogun, F, Pelosi, F, Morady, F & Oral, H 2013, 'Dabigatran vs warfarin for radiofrequency catheter ablation of atrial fibrillation', Heart Rhythm, vol. 10, no. 4, pp. 483-489. https://doi.org/10.1016/j.hrthm.2012.12.011
Kim J-S, She F, Jongnarangsin K, Chugh A, Latchamsetty R, Ghanbari H et al. Dabigatran vs warfarin for radiofrequency catheter ablation of atrial fibrillation. Heart Rhythm. 2013 Apr 1;10(4):483-489. https://doi.org/10.1016/j.hrthm.2012.12.011
Kim, Jin-Seok ; She, Fei ; Jongnarangsin, Krit ; Chugh, Aman ; Latchamsetty, Rakesh ; Ghanbari, Hamid ; Crawford, Thomas ; Suwanagool, Arisara ; Sinno, Mohammed ; Carrigan, Thomas ; Kennedy, Robert ; Saint-Phard, Wouter ; Yokokawa, Miki ; Good, Eric ; Bogun, Frank ; Pelosi, Frank ; Morady, Fred ; Oral, Hakan. / Dabigatran vs warfarin for radiofrequency catheter ablation of atrial fibrillation. In: Heart Rhythm. 2013 ; Vol. 10, No. 4. pp. 483-489.
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T1 - Dabigatran vs warfarin for radiofrequency catheter ablation of atrial fibrillation

AU - Kim, Jin-Seok

AU - She, Fei

AU - Jongnarangsin, Krit

AU - Chugh, Aman

AU - Latchamsetty, Rakesh

AU - Ghanbari, Hamid

AU - Crawford, Thomas

AU - Suwanagool, Arisara

AU - Sinno, Mohammed

AU - Carrigan, Thomas

AU - Kennedy, Robert

AU - Saint-Phard, Wouter

AU - Yokokawa, Miki

AU - Good, Eric

AU - Bogun, Frank

AU - Pelosi, Frank

AU - Morady, Fred

AU - Oral, Hakan

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N2 - Background: It is not clear whether dabigatran is as safe and effective as uninterrupted anticoagulation with warfarin during radiofrequency catheter ablation (RFA) of atrial fibrillation (AF). Objective: To compare the safety and efficacy of dabigatran by using a novel administration protocol and uninterrupted anticoagulation with warfarin for periprocedural anticoagulation in patients undergoing RFA of AF. Methods: In this case-control analysis, 763 consecutive patients (mean age 61±10 years) underwent RFA of AF using dabigatran (N = 191) or uninterrupted warfarin (N = 572) for periprocedural anticoagulation. In all patients, anticoagulation was started≥4 weeks before RFA. Dabigatran was held after the morning dose on the day before the procedure and resumed 4 hours after vascular hemostasis was achieved. Results: A transesophageal echocardiogram performed in all patients receiving dabigatran did not demonstrate an intracardiac thrombus. There were no thromboembolic complications in either group. The prevalence of major (4 of 191, 2.1%) and minor (5 of 191, 2.6%) bleeding complications in the dabigatran group were similar to those in the warfarin group (12 of 572, 2.1%; P = 1.0 and 19 of 572, 3.3%; P =.8, respectively). Pericardial tamponade occurred in 2 of 191 (1%) patients in the dabigatran group and in 7 of 572 (1.2%) patients in the warfarin group (P = 1.0). All patients who had a pericardial tamponade, including 2 in the dabigatran group, had uneventful recovery after perdicardiocentesis. On multivariate analysis, international normalized ratio (odds ratio [OR] 4.0; 95% confidence interval [CI] 1.1-15.0; P =.04), clopidogrel use (OR 4.2; 95% CI 1.5-12.3; P =.01), and CHA2DS2-VASc score (OR 1.4; 95% CI 1.1-1.8; P =.01) were the independent risk factors of bleeding complications only in the warfarin group. Conclusions: When held for approximately 24 hours before the procedure and resumed 4 hours after vascular hemostasis, dabigatran appears to be as safe and effective as uninterrupted warfarin for periprocedural anticoagulation in patients undergoing RFA of AF.

AB - Background: It is not clear whether dabigatran is as safe and effective as uninterrupted anticoagulation with warfarin during radiofrequency catheter ablation (RFA) of atrial fibrillation (AF). Objective: To compare the safety and efficacy of dabigatran by using a novel administration protocol and uninterrupted anticoagulation with warfarin for periprocedural anticoagulation in patients undergoing RFA of AF. Methods: In this case-control analysis, 763 consecutive patients (mean age 61±10 years) underwent RFA of AF using dabigatran (N = 191) or uninterrupted warfarin (N = 572) for periprocedural anticoagulation. In all patients, anticoagulation was started≥4 weeks before RFA. Dabigatran was held after the morning dose on the day before the procedure and resumed 4 hours after vascular hemostasis was achieved. Results: A transesophageal echocardiogram performed in all patients receiving dabigatran did not demonstrate an intracardiac thrombus. There were no thromboembolic complications in either group. The prevalence of major (4 of 191, 2.1%) and minor (5 of 191, 2.6%) bleeding complications in the dabigatran group were similar to those in the warfarin group (12 of 572, 2.1%; P = 1.0 and 19 of 572, 3.3%; P =.8, respectively). Pericardial tamponade occurred in 2 of 191 (1%) patients in the dabigatran group and in 7 of 572 (1.2%) patients in the warfarin group (P = 1.0). All patients who had a pericardial tamponade, including 2 in the dabigatran group, had uneventful recovery after perdicardiocentesis. On multivariate analysis, international normalized ratio (odds ratio [OR] 4.0; 95% confidence interval [CI] 1.1-15.0; P =.04), clopidogrel use (OR 4.2; 95% CI 1.5-12.3; P =.01), and CHA2DS2-VASc score (OR 1.4; 95% CI 1.1-1.8; P =.01) were the independent risk factors of bleeding complications only in the warfarin group. Conclusions: When held for approximately 24 hours before the procedure and resumed 4 hours after vascular hemostasis, dabigatran appears to be as safe and effective as uninterrupted warfarin for periprocedural anticoagulation in patients undergoing RFA of AF.

KW - Atrial fibrillation

KW - Bleeding

KW - Catheter ablation

KW - Dabigatran

KW - Warfarin

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