Feasibility and Safety of Uninterrupted Dabigatran Therapy in Patients Undergoing Ablation for Atrial Fibrillation

Abstract

Objective Uninterrupted oral warfarin strategy has become the standard protocol to prevent complications during catheter ablation (CA) for the treatment of atrial fibrillation (AF). However, little is known about the safety and efficacy of uninterrupted dabigatran therapy in patients undergoing CA for AF. Therefore, this study investigated the safety and efficacy of uninterrupted dabigatran therapy and compared the findings with those for uninterrupted warfarin therapy. Methods Bleeding and thromboembolic events during the periprocedural period were evaluated in 363 consecutive patients who underwent CA for AF at Nagoya University Hospital, and received uninterrupted dabigatran (n=173) or uninterrupted warfarin (n=190) for periprocedural anticoagulation. Results A total of 27 (7%) patients experienced either bleeding or thromboembolic complications. Major bleeding complications occurred in 2 (1%) patients in the dabigatran group (DG) and 2 (1%) patients in the warfarin group (WG). Eight (5%) patients in the DG and 9 (5%) patients in the WG experienced groin hematoma, a type of minor bleeding complication. Meanwhile, no patient in the DG and 1 (1%) in the WG developed cerebral ischemic stroke. Overall, there was no significant difference between the groups for any category. The activated partial thromboplastin time (APTT) independently predicted periprocedural complications in the DG. Conclusion Uninterrupted dabigatran therapy in CA for AF thus may be a safe and effective anticoagulant therapy, and appears to be closely similar to continuous warfarin; however, it is essential to pay close attention to the APTT values when using dabigatran during CA.

Choosing a particular oral anticoagulant and dose for stroke prevention in individual patients with non-valvular atrial fibrillation: part 1

“…33 Early experience with two NOACs (dabigatran and rivaroxaban) in conjunction with AF ablation has been reported from observational studies and case series. 34,35 A number of observational studies compared the safety and efficacy of dabigatran vs. VKAs for AF ablation. A meta-analysis of 10 mostly single-centre retrospective studies found significant heterogeneity, including different regimens of NOAC interruption before and after ablation.…”

Rivaroxaban for Periprocedural Anticoagulation Therapy in Japanese Patients Undergoing Catheter Ablation of Paroxysmal Non-Valvular Atrial Fibrillation

“…To date, the retrospective evaluation of the management of peri-AF ablation anticoagulation with DOACs in Japanese NVAF patients has been reported, showing that DOACs would be an alternative to warfarin. [6][7][8] However, to the best of our knowledge, this is the first report to evaluate the use of rivaroxaban in peri-ablation anticoagulation in Japanese NVAF patients in a prospective study. Kaseno, et al reported that total bleeding complications occurred significantly less frequently in 110 patients treated with dabigatran (4.5%) than in 101 patients with uninterrupted warfarin (12.9%; P < 0.05).…”

“…Cardiac tamponade occurred in 1% in the warfarin group, which was similar to the present study. 7) In the Japanese Catheter Ablation Registry of Atrial Fibrillation (J-CARAF), a nationwide survey of catheter ablation for AF, the incidence of pericardial effusion in 541 DOAC-treated patients (0.7%) was lower than in 1808 uninterrupted warfarintreated patients (2.6%, P < 0.05). The difference in the periprocedural anticoagulant strategy was not related to the frequency of other bleeding events (1.9% for DOACs versus 2.2% for warfarin).…”

“…1,3) Recently, direct oral anticoagulants (DOACs) have been accepted as a promising option for prevention of stroke in non-valvular AF (NVAF) patients, however, experience with the peri-ablation management of DOACs is limited. 1,[4][5][6][7][8] This study aimed to investigate the safety and feasibility of periprocedural anticoagulation therapy with rivaroxaban in Japanese patients undergoing paroxysmal NVAF ablation using radiofrequency (RF) energy.…”

Comparison of uninterrupted anticoagulation with dabigatran etexilate or warfarin in the periprocedural period for atrial fibrillation catheter ablation: Results of the Japanese subgroup of the RE‐CIRCUIT trial

“…A study in 363 Japanese patients comparing uninterrupted dabigatran treatment (n = 173) with warfarin (n = 190) showed a similar incidence of bleeding events in both groups. 16 In that study, MBEs occurred in 2 patients (1%) in each treatment group, and the minor bleeding events included groin hematoma (dabigatran, 5%; warfarin, 5%) and thromboembolic complications (dabigatran, 0%; warfarin, 1%). A randomized, controlled study was also conducted in Japan Percentages were calculated with the total number of patients per treatment as the denominator.…”