Dabigatran-Treated Patients Safely Undergo AF Ablation

December 18, 2012

ANN ARBOR, Michigan — Stopping dabigatran (Pradaxa, Boehringer Ingelheim) 24 hours prior to radiofrequency catheter ablation for atrial fibrillation (AF) and resuming anticoagulation four hours after the procedure is just as safe and effective as treating patients with uninterrupted warfarin therapy, according to the results of a new study [1].

"In patients receiving dabigatran, it appears to be safe to proceed with radiofrequency ablation as long as dabigatran is administered with the specified protocol and patient compliance is confirmed," report Dr Jin-Seok Kim (University of Michigan, Ann Arbor) and colleagues in a report published online December 12, 2012 in Heart Rhythm. "Although a specific antidote for dabigatran is not available, the outcomes of serious complications such as pericardial tamponade do not appear to be any different with dabigatran than with warfarin."

Previous studies that investigated periprocedural anticoagulation with dabigatran reported less favorable outcomes than treatment with uninterrupted warfarin during ablation of AF, but these anticoagulation protocols withheld dabigatran for just 12 hours.

In the present study, 191 consecutive patients underwent ablation for AF (53% paroxysmal AF and 44% persistent AF) and received dabigatran for perioperative anticoagulation. These patients were asked to take only the morning 150-mg dose of dabigatran the day before the procedure and to skip the evening dose and the dose the morning of the ablation. Dabigatran was restarted four hours after vascular hemostasis was achieved after sheath removal. A control group of 572 patients were treated with uninterrupted warfarin and had an INR of 2.0 to 3.0 the day of ablation.

The prevalence of major and minor bleeding complications was 2.1% and 2.6%, respectively, in the dabigatran-treated patients, and 2.1% and 3.3%, respectively, among those who received warfarin. The difference between treatments was not statistically significant. Pericardial tamponade occurred in two patients (1.0%) who received dabigatran and seven patients (1.2%) treated with warfarin, a nonsignificant between-treatment difference. All patients with pericardial tamponade recovered.

The researchers also observed no increased risk of left atrial appendage thrombus formation after withholding dabigatran for 24 hours before the ablation. Among those treated with warfarin, concomitant use of clopidogrel, a higher CHA2DS2-VASc score, and a higher INR were associated with an increased risk of bleeding complications.