Efficacy and safety of periprocedural dabigatran in patients undergoing catheter ablation of atrial fibrillation.
BACKGROUND
Periprocedural anticoagulation using uninterrupted warfarin could reduce the risk of thromboembolic complications of atrial fibrillation (AF) ablation. Few studies, however, have evaluated the efficacy and safety of periprocedural dabigatran in AF ablation.


RESULTS
A total of 211 consecutive patients who underwent AF ablation, including 110 patients who received 110mg dabigatran twice daily (group D) and 101 patients who received dose-adjusted warfarin (international normalized ratio, 2.0-3.0; group W), were evaluated. Dabigatran was discontinued on the morning of the procedure, and resumed on the next morning. Warfarin was continued throughout the procedure. During the procedure, heparin infusion was maintained to achieve an activated clotting time of >300s. Postprocedural cerebral magnetic resonance imaging (MRI) was performed in 60 patients (group D, n=31; group W, n=29). No periprocedural deaths or symptomatic thromboembolic complications were observed in either group. MRI indicated a silent cerebral infarction in 1 patient in each group. Five patients in group D and 11 in group W had minor bleeding (P=0.12). Cardiac tamponade occurred in 2 patients in group W, but in none in group D. Total bleeding complications occurred less frequently in group D (4.5%) than in group W (12.9%; P<0.05).


CONCLUSIONS
Dabigatran at a dose of 110mg twice daily was safe for AF ablation in patients with a relatively low risk of thromboemboli, suggesting that it may become an alternative to warfarin in those patients.
Division of Cardiology, Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi, Maebashi 371-0004, Japan. k-kaseno@cvc.pref.gunma.jp
Kenichi
K
Kaseno
Shigeto
S
Naito
Kohki
K
Nakamura
Tamotsu
T
Sakamoto
Takehito
T
Sasaki
Naofumi
N
Tsukada
Mamoru
M
Hayano
Suguru
S
Nishiuchi
Etsuko
E
Fuke
Yuko
Y
Miki
Keijiro
K
Nakamura
Eiji
E
Yamashita
Koji
K
Kumagai
Shigeru
S
Oshima
Hiroshi
H
Tada
D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects; D000991:Antithrombins / Q000008:administration & dosage* / Q000009:adverse effects; D001281:Atrial Fibrillation; D001562:Benzimidazoles / Q000008:administration & dosage* / Q000009:adverse effects; D017115:Catheter Ablation; D000069604:Dabigatran; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care / Q000379:methods*; D013923:Thromboembolism / Q000209:etiology / Q000517:prevention & control*; D014859:Warfarin / Q000008:administration & dosage / Q000009:adverse effects; D015091:beta-Alanine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*
D000925:Anticoagulants; D000991:Antithrombins; D001562:Benzimidazoles; D015091:beta-Alanine; D014859:Warfarin; D000069604:Dabigatran