Abstract 16656: Dabigatran is as Safe as Warfarin for Peri-Procedural Anticoagulation in Atrial Fibrillation Ablation: A Meta-Analysis
Introduction: Newer anticoagulants offer an alternative to warfarin in patients with atrial fibrillation. Studies and meta-analyses have shown that these drugs are at least as safe and efficacious as warfarin and may be more convenient. But the safety of these medications for patients undergoing atrial fibrillation (AF) ablation is still controversial.
Methods: We performed a meta-analysis of published studies comparing Dabigatran and Warfarin in patients undergoing atrial fibrillation ablation. Pubmed, Embase and Cochrane Central were searched. Retrospective and prospective Studies were included if they reported major and minor bleeding and embolic events. Studies were excluded if they lacked a control group, if they compared the drugs for procedures other than AF ablation, or had less than 30days follow up. Data was extracted on an intention-to-treat basis. Heterogeneity of the studies was analyzed by Cochran’s Q statistics. Mantel Haenszel OR was calculated with fixed effect model to combine studies.
Results: Nine studies with 3,552 patients were included in the analysis. Studies were homogeneous (I sqaure of 0-14% and p=0.32-0.82). Dabigatran was stopped the day prior to or day of the procedure and Coumadin was un-interrupted in all but one study each. Major bleeding complications (OR-1.17, 95% CI-0.68, 2.03, p-0.56) and thrombo-embolic complications (OR-2.12, 95% CI-0.79, 5.64, p-0.13) in patients receiving Dabigatran was comparable to those receiving warfarin. There was significantly lower minor bleeding complication with Dabigatran (OR-0.63, 95% CI- 0.43, 0.91, p-0.01 ) compared to warfarin. Sensitivity analysis excluding studies with interrupted Coumadin and dabigatran stopped more than a day prior to procedure yielded similar results.
Conclusion: Our findings show that dabigatran may be safely used in patients undergoing RF ablation for AF, especially if they were already on the drug.
- © 2013 by American Heart Association, Inc.