title: Use of dabigatran for periprocedural anticoagulation in patients undergoing catheter ablation for atrial fibrillation.
abstract: BACKGROUND
  Pulmonary vein isolation (PVI) for atrial fibrillation is associated with a transient increased risk of thromboembolic and hemorrhagic events. We hypothesized that dabigatran can be safely used as an alternative to continuous warfarin for the periprocedural anticoagulation in PVI.
  
  
  RESULTS
  A total of 999 consecutive patients undergoing PVI were included; 376 patients were on dabigatran (150 mg), and 623 patients were on warfarin with therapeutic international normalized ratio. [corrected] Dabigatran was held 1 to 2 doses before PVI and restarted at the conclusion of the procedure or as soon as patients were transferred to the nursing floor. Propensity score matching was applied to generate a cohort of 344 patients in each group with balanced baseline data. Total hemorrhagic and thromboembolic complications were similar in both groups, before (3.2% versus 3.9%; P=0.59) and after (3.2% versus 4.1%; P=0.53) matching. Major hemorrhage occurred in 1.1% versus 1.6% (P=0.48) before and 1.2% versus 1.5% (P=0.74) after matching in the dabigatran versus warfarin group, respectively. A single thromboembolic event occurred in each of the dabigatran and warfarin groups. Despite higher doses of intraprocedural heparin, the mean activated clotting time was significantly lower in patients who held dabigatran for 1 or 2 doses than those on warfarin.
  
  
  CONCLUSIONS
  Our study found no evidence to suggest a higher risk of thromboembolic or hemorrhagic complications with use of dabigatran for periprocedural anticoagulation in patients undergoing PVI compared with uninterrupted warfarin therapy.
authors.affiliation: Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Bassiouny
authors.forename: Walid
authors.initials: W
authors.lastname: Saliba
authors.forename: John
authors.initials: J
authors.lastname: Rickard
authors.forename: Mingyuan
authors.initials: M
authors.lastname: Shao
authors.forename: Albert
authors.initials: A
authors.lastname: Sey
authors.forename: Mariam
authors.initials: M
authors.lastname: Diab
authors.forename: David O
authors.initials: DO
authors.lastname: Martin
authors.forename: Ayman
authors.initials: A
authors.lastname: Hussein
authors.forename: Maurice
authors.initials: M
authors.lastname: Khoury
authors.forename: Bernard
authors.initials: B
authors.lastname: Abi-Saleh
authors.forename: Samir
authors.initials: S
authors.lastname: Alam
authors.forename: Jay
authors.initials: J
authors.lastname: Sengupta
authors.forename: P Peter
authors.initials: PP
authors.lastname: Borek
authors.forename: Bryan
authors.initials: B
authors.lastname: Baranowski
authors.forename: Mark
authors.initials: M
authors.lastname: Niebauer
authors.forename: Thomas
authors.initials: T
authors.lastname: Callahan
authors.forename: Niraj
authors.initials: N
authors.lastname: Varma
authors.forename: Mina
authors.initials: M
authors.lastname: Chung
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Tchou
authors.forename: Mohamed
authors.initials: M
authors.lastname: Kanj
authors.forename: Thomas
authors.initials: T
authors.lastname: Dresing
authors.forename: Bruce D
authors.initials: BD
authors.lastname: Lindsay
authors.forename: Oussama
authors.initials: O
authors.lastname: Wazni
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery*; D001562:Benzimidazoles / Q000008:administration & dosage* / Q000009:adverse effects; D016001:Confidence Intervals; D000069604:Dabigatran; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004562:Electrocardiography / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care / Q000379:methods; D011183:Postoperative Complications / Q000517:prevention & control; D011446:Prospective Studies; D012042:Registries; D018570:Risk Assessment; D012720:Severity of Illness Index; D015996:Survival Rate; D013923:Thromboembolism / Q000401:mortality / Q000517:prevention & control*; D015912:Thrombolytic Therapy / Q000379:methods; D016896:Treatment Outcome; D014859:Warfarin / Q000008:administration & dosage* / Q000009:adverse effects; D015091:beta-Alanine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*
chemical_list: D000925:Anticoagulants; D001562:Benzimidazoles; D015091:beta-Alanine; D014859:Warfarin; D000069604:Dabigatran
keywords: ablation; anticoagulants; catheter ablation; fibrillation; stroke
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