Document Detail


Dabigatran vs Warfarin for Radiofrequency Catheter Ablation of Atrial Fibrillation.
MedLine Citation:
PMID:  23237911     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: It is not clear whether dabigatran is as safe and effective as uninterrupted anticoagulation using warfarin during radiofrequency catheter ablation (RFA) of atrial fibrillation (AF). OBJECTIVE: To compare the safety and efficacy of dabigatran using a novel administration protocol, and uninterrupted anticoagulation with warfarin for periprocedural anticoagulation in patients undergoing RFA of AF. METHODS AND RESULTS: In this case-control analysis, 763 consecutive patients (mean age: 61±10 years) underwent RFA of AF using dabigatran (n=191) or uninterrupted warfarin (n=572) for periprocedural anticoagulation. In all patients, anticoagulation was started ≥4 weeks prior to RFA. Dabigatran was held after the morning dose on the day before the procedure and resumed 4 hours after vascular hemostasis was achieved. A TEE performed in all patients receiving dabigatran did not demonstrate an intracardiac thrombus. There were no thromboembolic complications in either group. The prevalence of major,4/191 (2.1%), and minor bleeding complications, 5/191 (2.6%) in the dabigatran group, were similar to those in the warfarin group,12/572 (2.1%, P=1.0), and 19/572 (3.3%, P=0.8), respectively. Pericardial tamponade occurred in 2/191 patients (1%) in the dabigatran and in 7/572 patients (1.2%) in the warfarin groups, respectively (P=1.0). All patients who had a pericardial tamponade including 2 in the dabigatran group had uneventful recovery after perdicardiocentesis. On multivariate analysis, INR (OR: 4.0, ±95% CI: 1.1-15.0; P=0.04), clopidogrel use (OR: 4.2, ±95% CI: 1.5-12.3; P=0.01), and CHA(2)DS(2)-VASc score (OR: 1.4, ±95% CI: 1.1-1.8; P=0.01) were theindependent risk factors of bleeding complications only in the warfarin group. CONCLUSIONS: When held ~24 hours prior to the procedure and resumed 4 hours after vascular hemostasis dabigatran appears to be as safe and effective as uninterrupted warfarin for periprocedural anticoagulation in patients undergoing RFA of AF.
Authors:
Jin-Seok Kim; Fei She; Krit Jongnarangsin; Aman Chugh; Rakesh Latchamsetty; Hamid Ghanbari; Thomas Crawford; Mohammed Sinno; Thomas Carrigan; Robert Kennedy; Wouter Saint-Phard; Miki Yokokawa; Eric Good; Frank Bogun; Frank Pelosi; Fred Morady; Hakan Oral
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-12-10
Journal Detail:
Title:  Heart rhythm : the official journal of the Heart Rhythm Society     Volume:  -     ISSN:  1556-3871     ISO Abbreviation:  Heart Rhythm     Publication Date:  2012 Dec 
Date Detail:
Created Date:  2012-12-14     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101200317     Medline TA:  Heart Rhythm     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2012. Published by Elsevier Inc.
Affiliation:
Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan.
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