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 language | English |
|---|---|
| Pages (from-to) | 483-489 |
| Number of pages | 7 |
| Journal | Heart Rhythm |
| Volume | 10 |
| Issue number | 4 |
| DOIs | |
| Publication status | Published - 2013 Apr 1 |
| Externally published | Yes |
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Keywords
- Atrial fibrillation
- Bleeding
- Catheter ablation
- Dabigatran
- Warfarin
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
- Physiology (medical)
Cite this
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 journal › Article
}
TY - JOUR
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
PY - 2013/4/1
Y1 - 2013/4/1
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
UR - http://www.scopus.com/inward/record.url?scp=84875753938&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84875753938&partnerID=8YFLogxK
U2 - 10.1016/j.hrthm.2012.12.011
DO - 10.1016/j.hrthm.2012.12.011
M3 - Article
C2 - 23237911
AN - SCOPUS:84875753938
VL - 10
SP - 483
EP - 489
JO - Heart Rhythm
JF - Heart Rhythm
SN - 1547-5271
IS - 4
ER -