Abstract 12630: Dabigatran vs. Warfarin Peri-ablation for Atrial Fibrillation: A Meta-analysis of Embolic and Bleeding Complications
Introduction: Dabigatran (D) is increasingly used in pts with atrial fibrillation (AF) for stroke prevention and as a result, many centers are now performing ablation procedures using peri-procedural D. There have been some concerns of a higher incidence of peri-procedural embolic rates for D when compared with warfarin (W), but studies may be too small to accurately compare anticoagulation regimens given low complication rates.
Methods: We attempted to pool and meta-analyze all published (abstracts/papers) studies to date which compared peri-procedural use of D vs W, with or without heparin bridging. Thorough literature search yielded 6 abstracts and one published multicenter study that compared the two peri-procedural regimens and outcomes. Bleeding complication was defined as pericardial effusion, groin hematoma, GI bleeding and embolic complication as stroke/TIA or pulmonary embolism. We used the Mantel-Haenszel fixed effect model for pooling the study results, and a random effects model was used for heterogeneous samples/results.
Results: There were a total of 694 pts on D regimen and 1181 pts on W. Patient groups were similar. Pre-procedure, D was stopped 2.5-48 hrs and restarted 1-48 hrs post-procedure, and in 818 (69%) pts W was uninterrupted. Composite bleeding rates in D group was 5.48% and in W group 7.20% (p=0.15). Composite embolic rates in D group was 1.62% and in W group 0.61% (p=0.09). Meta-analysis showed no difference in bleeding (OR=0.75, 95% CI 0.49-1.13; I2 = 67.1%) and embolic complications (OR=2.39, 95% CI 0.84-6.80; I2 = 0%) between the two regimens (Figure).
Conclusion: This meta-analysis demonstrates that D is an anticoagulation alternative in patients undergoing ablation for AF that is not associated with an increase in bleeding or embolic events relative to conventional W regimens. A randomized study to evaluate the two anticoagulation strategies is needed, especially given trend for higher embolic complication rates with D.
- © 2012 by American Heart Association, Inc.