Abstract 17642: Warfarin versus Dabigatran: The Coagulation Activity in the Left Atrium During Atrial Fibrillation Ablation
Background: Atrial fibrillation (AF) ablation is associated with the potential risk of periprocedural thromboembolic events. Previous studies suggested performing AF ablation with continuous warfarin reduced the risk of thromboembolic events, otherwise the safety and efficacy of periprocedural dabigatran was controversial. We aim to compare the differences of the coagulable state in the left atrium (LA) between the anticoagulation strategies.
Methods: We divided 158 patients who underwent AF ablation into 3 groups: ablation with off warfarin (n=100, WF-off group), ablation with perioperative warfarin therapy (n=33, WF group), and ablation with dabigatran therapy (n=25, D group). Warfarin was stopped 1 day before the procedure in WF-off group. Uninterrupted warfarin therapy was used in WF group and interrupted only on the morning of the procedure with dabigatran in D group. During AF ablation, the blood samples from the LA obtained immediately after the trans-septal puncture before heparin administration in each groups. The D-dimer level and soluble fibrin monomer complex (SFMC) level in the LA were evaluated.
Results: The prevalence of positive D-dimer (≥ 0.5 μg/ml) in the LA was observed 3% in WF group, 12% in D group, and 23% in WF-off group, respectively. SFMC levels in the LA were significantly lower in WF group compared with WF-off group (p<0.01). SFMC levels in D group tended to be higher compared with WF group, but lower compared with WF-off group.
Conclusions: The coagulation activity in the LA was lower with perioperative warfarin therapy than with dabigatran therapy. Even transient interruption of anticoagulant therapy may be associated with hypercoagulable status in the LA.
Author Disclosures: N. Hashimoto: None. T. Arimoto: None. Y. Yashiro: None. T. Iwayama: None. D. Ishigaki: None. Y. Kumagai: None. S. Nishiyama: None. H. Takahashi: None. T. Shishido: None. T. Miyamoto: None. J. Nitobe: None. H. Aoyama: None. T. Watanabe: None. I. Kubota: None.
- © 2014 by American Heart Association, Inc.