title: The use of dabigatran immediately after atrial fibrillation ablation.
abstract: BACKGROUND
  Atrial fibrillation (AF) ablation requires postprocedural anticoagulation to prevent thromboembolic events because of the ablation procedure itself or due to recurrent AF postprocedure. Dabigatran is a new anticoagulant and may be useful after AF ablation to prevent thromboembolic events.
  
  
  RESULTS
  We evaluated 123 consecutive patients who were started on dabigatran after AF ablation. Patients were given enoxaparin 0.5 mg/kg at the end of the procedure, which was repeated 12 hours later and then discontinued. Dabigatran was started 22 hours postablation with drug dose based on renal function. Primary outcomes were thromboembolic events, bleeding complications, and side effects over a 30-day follow-up period. The preablation anticoagulant was warfarin in 56 (45.5%) patients, dabigatran in 34 (27.6%), and aspirin in 26 (21.1%). Seven (5.7%) patients were on no anticoagulant before ablation. The patients on dabigatran before ablation with normal renal function had the drug stopped 36 hours preablation. There were no preprocedural or intraprocedural thromboembolic episodes or bleeding. Three patients received dabigatran 75 mg bid and the rest 150 mg bid. There were no postablation strokes, transient ischemic attacks, or systemic thromboemboli in any patient. Three patients discontinued dabigatran and were changed to warfarin, 2 because of gastrointestinal side effects and 1 because of a diffuse rash.
  
  
  CONCLUSIONS
  Dabigatran is safe and well tolerated after AF ablation. It did not cause bleeding complications and there were no thromboembolic events. Dabigatran appears to be an alternative to warfarin after AF ablation.
authors.affiliation: Cardiovascular Medicine and Cardiac Arrhythmias, E. Palo Alto, Sequoia Hospital, Redwood City, California, USA. rawinkle@aol.com
authors.forename: Roger A
authors.initials: RA
authors.lastname: Winkle
authors.forename: R Hardwin
authors.initials: RH
authors.lastname: Mead
authors.forename: Gregory
authors.initials: G
authors.lastname: Engel
authors.forename: Melissa H
authors.initials: MH
authors.lastname: Kong
authors.forename: Rob A
authors.initials: RA
authors.lastname: Patrawala
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D001241:Aspirin / Q000009:adverse effects / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000601:surgery*; D001562:Benzimidazoles / Q000009:adverse effects / Q000627:therapeutic use*; D017115:Catheter Ablation; D000069604:Dabigatran; D004361:Drug Tolerance; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006470:Hemorrhage / Q000150:complications / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D012189:Retrospective Studies; D013917:Thrombin / Q000037:antagonists & inhibitors; D013923:Thromboembolism / Q000517:prevention & control; D016896:Treatment Outcome; D014859:Warfarin / Q000009:adverse effects / Q000627:therapeutic use; D015091:beta-Alanine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D001562:Benzimidazoles; D010975:Platelet Aggregation Inhibitors; D015091:beta-Alanine; D014859:Warfarin; D013917:Thrombin; D000069604:Dabigatran; D001241:Aspirin