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Comparative Study
, 6 (3), 460-6

Use of Dabigatran for Periprocedural Anticoagulation in Patients Undergoing Catheter Ablation for Atrial Fibrillation

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Comparative Study

Use of Dabigatran for Periprocedural Anticoagulation in Patients Undergoing Catheter Ablation for Atrial Fibrillation

Mohamed Bassiouny et al. Circ Arrhythm Electrophysiol.

Erratum in

  • Circ Arrhythm Electrophysiol. 2013 Oct;6(5):e79

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.

Methods and 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.

Keywords: ablation; anticoagulants; catheter ablation; fibrillation; stroke.

Conflict of interest statement

Conflict of Interest Disclosures: None

Figures

Figure 1
Figure 1
Mean intraprocedural ACT measurements throughout the PVI procedure. (Left) Mean ACT measurements across the time categorized by the 3 treatment groups. (Right) Growth curves generated from the random coefficient mixed model repeated measures analysis showing predicted mean ACT measurements across the time stratified by the 3 treatment groups.
Figure 2
Figure 2
Kaplan-Meier estimates of the rates of first achieving ACT > 350 seconds following initial heparin bolus dose, stratified by the 3 treatment groups.

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