Efficacy and Safety of Periprocedural Dabigatran in Patients Undergoing Catheter Ablation of Atrial Fibrillation

Kaseno, Kenichi; Naito, Shigeto; Nakamura, Kohki; Sakamoto, Tamotsu; Sasaki, Takehito; Tsukada, Naofumi; Hayano, Mamoru; Nishiuchi, Suguru; Fuke, Etsuko; Miki, Yuko; Nakamura, Keijiro; Yamashita, Eiji; Kumagai, Koji; Oshima, Shigeru; Tada, Hiroshi

doi:10.1253/circj.cj-12-0498

Cited by 79 publications

(73 citation statements)

References 27 publications

(22 reference statements)

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“…Thus, their study was not one that demonstrates the superiority of dabigatran over warfarin. 4 In contrast, important results from a multicenter prospective registry comparing the feasibility and safety of dabigatran with uninterrupted warfarin have been reported by Lakkireddy et al 5 In their analysis comparing 145 patients on uninterrupted warfarin with 145 patients taking dabigatran, the latter group had a significantly higher rate of major bleeding complications (9 patients, 6%), all of which were pericardial tamponade requiring drainage. Major bleeding (pericardial tamponade) was observed in only one patient (1%) in the warfarin group.…”

Section: Article P 2337mentioning

confidence: 95%

Can Dabigatran Be an Alternative Periprocedural Anticoagulation for Atrial Fibrillation Ablation?

Takahashi¹

2012

Circ J

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Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp he number of patients undergoing catheter ablation for atrial fibrillation (AF) has been increasing year by year. As noted in the updated guideline (ACC/AHA/ ESC) for the management of patients with AF, 1 embolic stroke is one of the most serious complications of AF ablation procedures. A higher intensity of anticoagulation is required to reduce the risk of thrombus formation during ablation. The recent 2012 HRS/EHRA/ECAS expert consensus statement notes that uninterrupted warfarin is a potential alternative to bridging with low-molecular-weight heparin. 2 In fact, in Japan, most of the large-volume centers adopt continuation of periprocedural warfarin in the therapeutic range. However, warfarin takes a long time to reach to its therapeutic range and there are some patients in whom it is difficult to control warfarin within the therapeutic range. Dabigatran, an oral direct thrombin inhibitor, was recently approved for the prevention of embolic stroke in patients with nonvalvular AF. 3 Therefore, there has been an interest in taking advantage of dabigatran around the time of catheter ablation. Three reports that evaluated the safety of periprocedural use of dabigatran for AF ablation in comparison with warfarin have been recently published. 4-6 Article p 2337In this issue of the Journal, Kaseno et al 4 demonstrate that dabigatran at a dose of 110 mg twice daily was safe in AF ablation. In their study, 110 patients treated with dabigatran developed no symptomatic thromboembolic complications. No patients had pericardial tamponade, and minor bleeding was observed in only 5 patients. These observations suggest that dabigatran could be a safe alternative strategy. However, caution is needed when interpreting this study. First of all, as the authors acknowledge, up to 92% of the patients had a CHADS2 score of 1 or 0, indicating essentially low risk for both thromboembolic and bleeding complications. Together with the fact that the authors' center is one of the largest-volume centers in Japan, with many experts for AF ablation, the observations cannot be wholly applicable to general AF ablation performed in medium-and low-volume centers. In addition, their study was retrospective and there was significant background inequality between the dabigatran and warfarin groups. For example, age was younger and left atrial dimension smaller in the dabigatran group. The number of patients having persistent AF was lower in the dabigatran group. Thus, their study was not one that demonstrates the superiority of dabigatran over warfarin. 4In contrast, important results from a multicenter prospective registry comparing the feasibility and safety of dabigatran with uninterrupted warfarin have been reported by Lakkireddy et al. 5 In their analysis comparing 145 patients on uninterrupted warfarin with 145 patients taking dabigatran, the latter group had a significantly higher rate of major bleeding complications (9 patients, 6%), all of wh...

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Section: Article P 2337mentioning

confidence: 95%

Can Dabigatran Be an Alternative Periprocedural Anticoagulation for Atrial Fibrillation Ablation?

Takahashi¹

2012

Circ J

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“…52 Regarding the periablation use of NOACs, data accumulated over the past few years mostly rely upon small, often retrospective, observational studies on dabigatran (there are no published data on factor Xa inhibitors in patients undergoing AF ablation, as yet), with significant differences in study design, patients' characteristics or procedure-related factors, all of which might have contributed to the contrasting results of those studies. [53][54][55][56][57][58][59][60] In general, late discontinuation of dabigatran (<24 h) before ablation and/or too early reinitiation of dabigatran (within first several hours after the procedure) were associated with increased risk of both thromboembolic and bleeding events compared with uninterrupted warfarin, while an earlier dabigatran discontinuation and later reinitiation (≥4 h after the procedure), with appropriate LMWH bridging, appeared to be as safe and effective as uninterrupted warfarin. However, the most recent study (also retrospective, but the largest published so far) found that uninterrupted administration of dabigatran 150 mg twice daily (including the day of the procedure), was as safe and effective as uninterrupted warfarin.…”

Section: Periprocedural Cessation Of Oral Anticoagulant Therapymentioning

confidence: 97%

Anticoagulation management in nonvalvular atrial fibrillation: current and future directions

Kornej¹,

Potpara²,

Lip³

2013

Polish Archives of Internal Medicine

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“…The evidence network for the primary analysis (figure 2) included 31 studies and six observational studies (52,(55)(56)(57)(58)62)) reporting on 287, 692 patients exposed to 230, 090 years of anticoagulant medication. We were unable to separate out upper and lower GI bleeds as most of the studies did not include this information.…”

Section: Major Gi Bleedingmentioning

confidence: 99%

Risk of gastrointestinal bleeding with direct oral anticoagulants: a systematic review and network meta-analysis

Burr

Lummis

Sood

et al. 2017

The Lancet Gastroenterology & Hepatology

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Efficacy and Safety of Periprocedural Dabigatran in Patients Undergoing Catheter Ablation of Atrial Fibrillation

Cited by 79 publications

References 27 publications

Can Dabigatran Be an Alternative Periprocedural Anticoagulation for Atrial Fibrillation Ablation?

Can Dabigatran Be an Alternative Periprocedural Anticoagulation for Atrial Fibrillation Ablation?

Anticoagulation management in nonvalvular atrial fibrillation: current and future directions

Risk of gastrointestinal bleeding with direct oral anticoagulants: a systematic review and network meta-analysis

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