• Circ Arrhythm Electrophysiol · Jun 2013

    Comparative Study

    Use of dabigatran for periprocedural anticoagulation in patients undergoing catheter ablation for atrial fibrillation.

    • Mohamed Bassiouny, Walid Saliba, John Rickard, Mingyuan Shao, Albert Sey, Mariam Diab, David O Martin, Ayman Hussein, Maurice Khoury, Bernard Abi-Saleh, Samir Alam, Jay Sengupta, P Peter Borek, Bryan Baranowski, Mark Niebauer, Thomas Callahan, Niraj Varma, Mina Chung, Patrick J Tchou, Mohamed Kanj, Thomas Dresing, Bruce D Lindsay, and Oussama Wazni.
    • Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
    • Circ Arrhythm Electrophysiol. 2013 Jun 1;6(3):460-6.

    BackgroundPulmonary 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 ResultsA 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.ConclusionsOur 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.

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