Abstract 14708: Pradaxa Can Be Safely Used As Monotherapy Or As A Bridge To Therapeutic Warfarin After Atrial Fibrillation Ablation
Background: After catheter ablation for atrial fibrillation (AF), it is recommended that all patients be treated with warfarin for 2 months and in those with a CHADS2 ≥2 indefinitely. Dabigatran recently has been shown to be as effective as warfarin with a time to therapeutic range similar to enoxaparin. The objective of this study was to report the use of dabigatran as both mono-therapy and as a bridge to therapeutic warfarin after AF ablation.
Methods: 108 patients underwent an ablation procedures using an open irrigated tip catheter for symptomatic AF and treated post ablation with dabigatran were followed with careful attention to medication side effects, minor and major bleeding, and thromboembolism during the first 3 months post-ablation. Dabigatran was started in these patients 6 hours after the access sheaths were removed.
Results: Of the 108 patients, 61% were male with an average age of 66±11 years. Coexistent cardiovascular diseases included: diabetes in 21%, hypertension in 81%, heart failure in 39%, and prior stroke in 4%. AF was paroxysmal in 56%, persistent in 28%, and longstanding persistent in 16%. Dabigatran was used as a bridge to therapeutic warfarin in 59% and as monotherapy in 41%. During the first 3 months, 2 patients discontinued dabigatran due to dyspepsia despite all patients being treated with a proton pump inhibitor. Access site bleeds prompted early termination of dabigatran in 2 patients, both being bridged. In both of these patients the bleeds were treated conservatively with discontinuation of the dabigatran. There were no observed late effusions, vascular injuries requiring surgery, or TIA/cerebral vascular accidents.
Conclusion: Patients who undergo a left atrial ablation for AF with a subtherapeutic warfarin can be safely treated with pradaxa as a bridge to a therapeutic warfarin or as monotherapy.
- © 2011 by American Heart Association, Inc.