title: Dabigatran vs warfarin for radiofrequency catheter ablation of atrial fibrillation.
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.
authors.affiliation: Cardiovascular Medicine, University of Michigan, Ann Arbor, MI 48105-5853, USA.
authors.forename: Jin-Seok
authors.initials: JS
authors.lastname: Kim
authors.forename: Fei
authors.initials: F
authors.lastname: She
authors.forename: Krit
authors.initials: K
authors.lastname: Jongnarangsin
authors.forename: Aman
authors.initials: A
authors.lastname: Chugh
authors.forename: Rakesh
authors.initials: R
authors.lastname: Latchamsetty
authors.forename: Hamid
authors.initials: H
authors.lastname: Ghanbari
authors.forename: Thomas
authors.initials: T
authors.lastname: Crawford
authors.forename: Arisara
authors.initials: A
authors.lastname: Suwanagool
authors.forename: Mohammed
authors.initials: M
authors.lastname: Sinno
authors.forename: Thomas
authors.initials: T
authors.lastname: Carrigan
authors.forename: Robert
authors.initials: R
authors.lastname: Kennedy
authors.forename: Wouter
authors.initials: W
authors.lastname: Saint-Phard
authors.forename: Miki
authors.initials: M
authors.lastname: Yokokawa
authors.forename: Eric
authors.initials: E
authors.lastname: Good
authors.forename: Frank
authors.initials: F
authors.lastname: Bogun
authors.forename: Frank
authors.initials: F
authors.lastname: Pelosi
authors.forename: Fred
authors.initials: F
authors.lastname: Morady
authors.forename: Hakan
authors.initials: H
authors.lastname: Oral
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000188:drug therapy* / Q000601:surgery*; D001562:Benzimidazoles / Q000009:adverse effects / Q000627:therapeutic use*; D016022:Case-Control Studies; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods*; D000069604:Dabigatran; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D017548:Echocardiography, Transesophageal / Q000379:methods; D004562:Electrocardiography / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011182:Postoperative Care; D011237:Predictive Value of Tests; D011300:Preoperative Care; D012016:Reference Values; D018570:Risk Assessment; D012720:Severity of Illness Index; 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; D015091:beta-Alanine; D014859:Warfarin; D000069604:Dabigatran