title: Comparative safety of periablation anticoagulation strategies for atrial fibrillation: data from a large multicenter study.
abstract: BACKGROUND
  There are a variety of periprocedural anticoagulation strategies for atrial fibrillation (AF) ablation, including the use of dabigatran. It is unclear which strategy is superior.
  
  
  OBJECTIVE
  To compare the safety and efficacy of anticoagulation with uninterrupted warfarin, dabigatran, and warfarin with heparin bridging in patients undergoing ablation of AF at four experienced centers.
  
  
  RESULTS
  In this retrospective analysis, 882 patients (mean age: 61 ± 11 years) underwent ablation of AF using uninterrupted warfarin (n = 276), dabigatran (n = 374), or warfarin with heparin bridging (n = 232) for periprocedural anticoagulation. The rate of total complications was 23/276 (8.3%) in the uninterrupted warfarin group, 30/374 (8.0%) in the dabigatran group, and 29/232 (12.5%) in the bridged group (P = 0.15). Major complications were more frequent in the uninterrupted warfarin group 12/276 (4.3%) compared with 3/374 (0.8%) in dabigatran and 6/232 (2.6%) in the bridged group (P = 0.01). The most common major complication was the need for transfusion or occurrence of major bleeding. Minor complications did not differ among the three groups. On multivariate analysis, female gender (odds ratio [OR] 1.93, confidence interval [CI] 1.16-3.19, P = 0.011), bridging heparin (OR 2.13, CI 1.100-3.941, P = 0.016), use of triple antithrombotic therapy (OR 1.77, CI 1.05-2.98, P = 0.033), and prior myocardial infarction (OR 2.40, CI 1.01-5.67, P = 0.046) independently predicted total complications.
  
  
  CONCLUSIONS
  When comparing the use of uninterrupted warfarin, dabigatran, and warfarin with heparin bridging in patients undergoing catheter ablation of AF, dabigatran was not associated with increased risk, major complications were more common in the uninterrupted warfarin group, and after adjustment, warfarin with bridging increased total complications.
authors.affiliation: Arrhythmia Institute, Valley Health System, New York, New York and Ridgewood, New Jersey.
authors.forename: Aysha
authors.initials: A
authors.lastname: Arshad
authors.forename: Christopher K
authors.initials: CK
authors.lastname: Johnson
authors.forename: Suneet
authors.initials: S
authors.lastname: Mittal
authors.forename: Eric
authors.initials: E
authors.lastname: Buch
authors.forename: Ismail
authors.initials: I
authors.lastname: Hamam
authors.forename: Thanh
authors.initials: T
authors.lastname: Tran
authors.forename: Richard E
authors.initials: RE
authors.lastname: Shaw
authors.forename: Dan
authors.initials: D
authors.lastname: Musat
authors.forename: Mark
authors.initials: M
authors.lastname: Preminger
authors.forename: Tina
authors.initials: T
authors.lastname: Sichrovsky
authors.forename: Bengt
authors.initials: B
authors.lastname: Herweg
authors.forename: Kalyanam
authors.initials: K
authors.lastname: Shivkumar
authors.forename: John
authors.initials: J
authors.lastname: Hummel
authors.forename: Jonathan S
authors.initials: JS
authors.lastname: Steinberg
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000401:mortality* / Q000601:surgery*; D016063:Blood Loss, Surgical / Q000401:mortality* / Q000517:prevention & control; D017115:Catheter Ablation / Q000401:mortality*; D015897:Comorbidity; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000401:mortality* / Q000517:prevention & control; D015996:Survival Rate; D013923:Thromboembolism / Q000401:mortality / Q000517:prevention & control*; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
chemical_list: D000925:Anticoagulants
keywords: ablation; atrial fibrillation; pharmacology