Periprocedural dabigatran in patients undergoing pulmonary vein isolation had similar rates of hemorrhagic and thromboembolic complications compared to continuous warfarin (3.2% vs 4.1%; P=0.53).
Cohort (n=999)
Does periprocedural dabigatran prevent hemorrhagic and thromboembolic complications compared to continuous warfarin in patients undergoing catheter ablation for atrial fibrillation?
Periprocedural dabigatran (held for 1-2 doses) is a safe alternative to uninterrupted warfarin during pulmonary vein isolation for atrial fibrillation, with no significant difference in bleeding or thromboembolic complications.
Absolute Event Rate: 3.2% vs 4.1%
p-value: p=0.53
BACKGROUND: Pulmonary vein isolation (PVI) for atrial fibrillation is associated with a transient increased risk of thromboembolic and hemorrhagic events. We hypothesized that dabigatran can be safely used as an alternative to continuous warfarin for the periprocedural anticoagulation in PVI. METHODS AND RESULTS: A total of 999 consecutive patients undergoing PVI were included; 376 patients were on dabigatran (150 mg), and 623 patients were on warfarin with therapeutic international normalized ratio. corrected Dabigatran was held 1 to 2 doses before PVI and restarted at the conclusion of the procedure or as soon as patients were transferred to the nursing floor. Propensity score matching was applied to generate a cohort of 344 patients in each group with balanced baseline data. Total hemorrhagic and thromboembolic complications were similar in both groups, before (3.2% versus 3.9%; P=0.59) and after (3.2% versus 4.1%; P=0.53) matching. Major hemorrhage occurred in 1.1% versus 1.6% (P=0.48) before and 1.2% versus 1.5% (P=0.74) after matching in the dabigatran versus warfarin group, respectively. A single thromboembolic event occurred in each of the dabigatran and warfarin groups. Despite higher doses of intraprocedural heparin, the mean activated clotting time was significantly lower in patients who held dabigatran for 1 or 2 doses than those on warfarin. CONCLUSIONS: Our study found no evidence to suggest a higher risk of thromboembolic or hemorrhagic complications with use of dabigatran for periprocedural anticoagulation in patients undergoing PVI compared with uninterrupted warfarin therapy.
Bassiouny et al. (Thu,) conducted a cohort in Atrial fibrillation (n=999). Dabigatran vs. Continuous warfarin was evaluated on Total hemorrhagic and thromboembolic complications (p=0.53). Periprocedural dabigatran in patients undergoing pulmonary vein isolation had similar rates of hemorrhagic and thromboembolic complications compared to continuous warfarin (3.2% vs 4.1%; P=0.53).