Abstract 13128: Use of Dabigatran for Peri-Procedural Anticoagulation in Patients Undergoing Catheter Ablation for Atrial fibrillation: A New Paradigm in Peri-Procedural Anticoagulation
Background: Pulmonary vein isolation (PVI) for the treatment of atrial fibrillation (AF) is associated with a transient increased risk of thromboembolic and hemorrhagic events. Continuation of warfarin at a therapeutic international normalized ratio (INR) at the time of PVI is a safe and efficacious peri-procedural anticoagulation strategy. With the availability of dabigatran, however, a new simplified paradigm in peri-procedural anticoagulation may emerge.
Hypothesis: We assessed the hypothesis that dabigatran can be used as a safe alternative to continuous warfarin therapy for the peri-operative management of anticoagulation in patients undergoing PVI.
Methods: All patients undergoing PVI while on dabigatran (150 mg) as the sole anticoagulant were enrolled. These patients were compared to a similar cohort of patients undergoing PVI taking warfarin during a similar time period. Patients in the warfarin arm with an INR<1.8 were excluded. Patients on Dabigatran were instructed to hold 1-2 doses prior to the procedure. Dabigatran was restarted in the EP lab at the conclusion of the procedure or as soon as the patients arrived to the nursing floor. The incidence of peri-procedural cerebrovascular events and hemorrhagic complications, total heparin doses, and the activated clotting time (ACT) levels throughout the ablation procedure were compared between the two groups.
Results: 101 patients met inclusion criteria of which 47 received dabigatran and 54 warfarin. Age, gender, body mass index, common comorbidities, CHADS II score, and procedure duration were similar in the two groups. The total heparin dose/kg in the dabigatran arm was significantly greater than that in the warfarin arm (209.2±55.5 vs. 151.4±36.0, p=<0.0001). Despite the greater doses of heparin, the mean ACT in the dabigatran arm was significantly less than that in the warfarin arm (342.0±49.4 vs. 382.0±35.4, p=<0.0001). No peri-procedural cerebrovascular events or major hemorrhagic complications were noted in either group.
Conclusion: Dabigatran appears to be a safe alternative to warfarin in the peri-procedural period in patients undergoing PVI. Importantly, substantially greater doses of heparin are needed with the use of dabigatran to achieve adequate ACT levels.
- © 2011 by American Heart Association, Inc.