NEW YORK (Reuters Health) – In patients with atrial fibrillation undergoing radiofrequency catheter ablation, complication risks are higher with use of dabigatran for anticoagulation compared with uninterrupted warfarin, researchers report in the Journal of the American College of Cardiology for March 27.
“Further studies are needed to identify the optimal periprocedural anticoagulation strategies in patients on dabigatran undergoing AF ablation,” the authors conclude.
Dr. Dhanunjaya Lakkireddy, with the University of Kansas Hospital and Medical Center, Kansas City, and colleagues explain that dabigatran has been shown to be better than warfarin in preventing stroke in AF patient, but the safety of dabigatran and its efficacy as an anticoagulant to reduce thromboembolic risk during AF ablation are unknown.
To investigate, the team examined data from a prospective registry of patients undergoing radiofrequency catheter ablation for AF. For the study, all 145 patients taking periprocedural dabigatran were matched to the same number of patients on warfarin. Dabigatran was stopped on the morning of the procedure and resumed 3 hours after, while warfarin was continued without interruption.
Thromboembolic complications occurred in three patients, all in the dabigatran group, the researchers found. Also, the rate of major bleeding was 6% in the dabigatran arm compared with 1% in the warfarin group (p=0.019).
On multivariable analysis the only independent predictors of bleeding or thromboembolic risk were use of dabigatran (odds ratio 2.76; p=0.01) and age over 75 (OR 3.82; p=0.04), the report indicates.
“Although our study provides initial data on slightly increased bleeding with dabigatran compared with warfarin in patients undergoing AF ablation, large randomized, controlled studies are required to confirm our results and identify an optimal periprocedural anticoagulation protocol,” Dr. Lakkireddy and colleagues conclude.
“It is possible that holding dabigatran for >24 h without delaying the first dose after the procedure may decrease these bleeding complications and needs to be evaluated in future studies,” they suggest. “The lack of any recommended acute reversal agents for dabigatran, at present, makes the risk of excessive major bleeding complications all the more important.”
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