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

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129 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

Keywords

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

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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    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, 10(4), 483-489. https://doi.org/10.1016/j.hrthm.2012.12.011