Abstract 18989: Periprocedural Heparin Requirement in Patients Undergoing Atrial Fibrillation Ablation Stratified by Different Baseline Anticoagulation Regimens: Evidence for a Prothrombotic State With Interrupted Dabigatran
Introduction: Thromboembolic (TE) and bleeding complications represent the most common adverse events during atrial fibrillation (AF) ablation. In order to prevent TE, unfractionated heparin (UFH) is recommended throughout the procedure, with a target ACT of 350-400 sec.
In this study we compared periprocedural heparin requirements during different pre-procedure anticoagulation regimens and the potential clinical implications.
Methods: We retrospectively analyzed every case of AF ablation performed at our institution over the last 2 years, including only first time ablations, and collected the amount of UFH per kilogram needed to achieve the target ACT.
The groups were compared based on the periprocedural anticoagulation strategy (warfarin vs. dabigatran vs. rivaroxaban), and the number of doses held before the procedure.
Patients on warfarin were all on uninterrupted warfarin, but for comparison we further subdivided this group into INR tertiles, based on INR at time of procedure.
Results: We included 584 patients. Of those 391 (67%) were on warfarin, 162 (28%) were receiving dabigatran and 31 (5%) rivaroxaban. Baseline characteristics were not significantly different
between the groups, including procedural duration and baseline creatinine. 54.1% had paroxysmal AF and 5.3% had a prior TIA/stroke.
Patients that held ≥2 doses of dabigatran needed significantly more UFH-per-kilogram-per-procedure, as compared to patients on warfarin with INR <1.5. (15% more; p=0.029). See figure.
No differences were observed between those on warfarin with INR ≤1.5 and those holding ≥2 doses rivaroxaban (p=0.56).
No significant differences were observed in the rate of bleeding or TE complications between groups (P=0.18).
Conclusions: Interrupted dabigatran is associated with significantly increased need for UFH compared to those functionally off warfarin, which may suggest a slight rebound procoagulant effect due to dabigatran interruption.
Author Disclosures: D. Benhayon: None. P. Santangeli: None. E. Zado: None. J. Ryan: None. D. Callans: Honoraria; Modest; Biosense Webster, Medtronic, St. Jude Medical, Biotronik. Honoraria; Significant; Boston Scientific. F. Marchlinski: None.
- © 2014 by American Heart Association, Inc.