Feasibility and safety of dabigatran versus warfarin for periprocedural anticoagulation in patients undergoing radiofrequency ablation for atrial fibrillation: Results from a multicenter prospective registry

Dhanunjaya Lakkireddy, Yeruva Madhu Reddy, Luigi Di Biase, Subba Reddy Vanga, Pasquale Santangeli, Vijay Swarup, Rhea Pimentel, Moussa C. Mansour, Andre D'Avila, Javier E. Sanchez, J. David Burkhardt, Fadi Chalhoub, Prasant Mohanty, James Coffey, Naushad Shaik, George Monir, Vivek Y. Reddy, Jeremy Ruskin, Andrea Natale

Research output: Contribution to journalArticle

240 Scopus citations

Abstract

Objectives: The purpose of this study was to evaluate the feasibility and safety of periprocedural dabigatran during atrial fibrillation (AF) ablation. Background: AF ablation requires optimal periprocedural anticoagulation for minimizing bleeding and thromboembolic complications. The safety and efficacy of dabigatran as a periprocedural anticoagulant for AF ablation are unknown. Methods: We performed a multicenter, observational study from a prospective registry including all consecutive patients undergoing AF ablation in 8 high-volume centers in the United States. All patients receiving dabigatran therapy who underwent AF ablation on periprocedural dabigatran, with the dose held on the morning of the procedure, were matched by age, sex, and type of AF with an equal number of patients undergoing AF ablation with uninterrupted warfarin therapy over the same period. Results: A total of 290 patients, including 145 taking periprocedural dabigatran and an equal number of matched patients taking uninterrupted periprocedural warfarin, were included in the study. The mean age was 60 years with 79% being male and 57% having paroxysmal AF. Both groups had a similar CHADS 2 score, left atrial size, and left ventricular ejection fraction. Three thromboembolic complications (2.1%) occurred in the dabigatran group compared with none in the warfarin group (p = 0.25). The dabigatran group had a significantly higher major bleeding rate (6% vs. 1%; p = 0.019), total bleeding rate (14% vs. 6%; p = 0.031), and composite of bleeding and thromboembolic complications (16% vs. 6%; p = 0.009) compared with the warfarin group. Dabigatran use was confirmed as an independent predictor of bleeding or thromboembolic complications (odds ratio: 2.76, 95% confidence interval: 1.22 to 6.25; p = 0.01) on multivariate regression analysis. Conclusions: In patients undergoing AF ablation, periprocedural dabigatran use significantly increases the risk of bleeding or thromboembolic complications compared with uninterrupted warfarin therapy.

Original languageEnglish (US)
Pages (from-to)1168-1174
Number of pages7
JournalJournal of the American College of Cardiology
Volume59
Issue number13
DOIs
StatePublished - Mar 27 2012
Externally publishedYes

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Keywords

  • anticoagulation
  • atrial fibrillation ablation
  • dabigatran
  • matched case-control study
  • periprocedural complications

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Lakkireddy, D., Reddy, Y. M., Di Biase, L., Vanga, S. R., Santangeli, P., Swarup, V., Pimentel, R., Mansour, M. C., D'Avila, A., Sanchez, J. E., Burkhardt, J. D., Chalhoub, F., Mohanty, P., Coffey, J., Shaik, N., Monir, G., Reddy, V. Y., Ruskin, J., & Natale, A. (2012). Feasibility and safety of dabigatran versus warfarin for periprocedural anticoagulation in patients undergoing radiofrequency ablation for atrial fibrillation: Results from a multicenter prospective registry. Journal of the American College of Cardiology, 59(13), 1168-1174. https://doi.org/10.1016/j.jacc.2011.12.014