Feasibility and safety of dabigatran versus warfarin for periprocedural anticoagulation in patients undergoing radiofrequency ablation for atrial fibrillation: results from a multicenter prospective registry.
OBJECTIVE
The purpose of this study was to evaluate the feasibility and safety of periprocedural dabigatran during atrial fibrillation (AF) ablation.


BACKGROUND
AF ablation requires optimal periprocedural anticoagulation for minimizing bleeding and thromboembolic complications. The safety and efficacy of dabigatran as a periprocedural anticoagulant for AF ablation are unknown.


METHODS
We performed a multicenter, observational study from a prospective registry including all consecutive patients undergoing AF ablation in 8 high-volume centers in the United States. All patients receiving dabigatran therapy who underwent AF ablation on periprocedural dabigatran, with the dose held on the morning of the procedure, were matched by age, sex, and type of AF with an equal number of patients undergoing AF ablation with uninterrupted warfarin therapy over the same period.


RESULTS
A total of 290 patients, including 145 taking periprocedural dabigatran and an equal number of matched patients taking uninterrupted periprocedural warfarin, were included in the study. The mean age was 60 years with 79% being male and 57% having paroxysmal AF. Both groups had a similar CHADS(2) score, left atrial size, and left ventricular ejection fraction. Three thromboembolic complications (2.1%) occurred in the dabigatran group compared with none in the warfarin group (p = 0.25). The dabigatran group had a significantly higher major bleeding rate (6% vs. 1%; p = 0.019), total bleeding rate (14% vs. 6%; p = 0.031), and composite of bleeding and thromboembolic complications (16% vs. 6%; p = 0.009) compared with the warfarin group. Dabigatran use was confirmed as an independent predictor of bleeding or thromboembolic complications (odds ratio: 2.76, 95% confidence interval: 1.22 to 6.25; p = 0.01) on multivariate regression analysis.


CONCLUSIONS
In patients undergoing AF ablation, periprocedural dabigatran use significantly increases the risk of bleeding or thromboembolic complications compared with uninterrupted warfarin therapy.
Division of Cardiovascular Diseases, Cardiovascular Research Institute, Mid America Cardiology, University of Kansas Hospital and Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160-7200, USA. dlakkireddy@mac.md
Dhanunjaya
D
Lakkireddy
Yeruva Madhu
YM
Reddy
Luigi
L
Di Biase
Subba Reddy
SR
Vanga
Pasquale
P
Santangeli
Vijay
V
Swarup
Rhea
R
Pimentel
Moussa C
MC
Mansour
Andre
A
D'Avila
Javier E
JE
Sanchez
J David
JD
Burkhardt
Fadi
F
Chalhoub
Prasant
P
Mohanty
James
J
Coffey
Naushad
N
Shaik
George
G
Monir
Vivek Y
VY
Reddy
Jeremy
J
Ruskin
Andrea
A
Natale
D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000628:therapy*; D001562:Benzimidazoles / Q000009:adverse effects / Q000627:therapeutic use*; D017115:Catheter Ablation; D000069604:Dabigatran; D005240:Feasibility Studies; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care; D011446:Prospective Studies; D012042:Registries; D013923:Thromboembolism / Q000139:chemically induced; D016896:Treatment Outcome; D014859:Warfarin / Q000627:therapeutic use*; D015091:beta-Alanine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use
D000925:Anticoagulants; D001562:Benzimidazoles; D015091:beta-Alanine; D014859:Warfarin; D000069604:Dabigatran