Dabigatran vs warfarin for radiofrequency catheter ablation of atrial fibrillation

초록

BACKGROUND It is not dear whether dabigatran is as safe and effective as uninterrupted anticoagulation with warfarin during radiofrequency catheter ablation (RFA) of atria L fibrillation (AF). OBJECTIVE To compare the safety and efficacy of dabigatran by using a novel administration protocol and uninterrupted anticoagulation with warfarin for periprocedural anticoagulation in patients undergoing RFA of AF. METHODS In this case-control analysis, 763 consecutive patients (mean age 61 +/- 10 years) underwent RFA of AF using dabigatran (N = 191) or uninterrupted warfarin (N = 572) for periprocedural anticoagulation. In all patients, anticoagulation was started >= 4 weeks before RFA. Dabigatran was herd after the morning dose on the day before the procedure and resumed 4 hours after vascular hemostasis was achieved. RESULTS A transesophageal echocardiogram performed in all patients receiving dabigatran did not demonstrate an intracardiac thrombus. There were no thromboembolic complications in either group. The prevalence of major (4 of 191, 2.1%) and minor (5 of 191, 2.6%) breeding complications in the dabigatran group were similar to those in the warfarin group (12 of 572, 2.1%; P = 1.0 and 19 of 572, 3.3%; P = .8, respectively). Pericardia l. tamponade occurred in 2 of 191 (1%) patients in the dabigatran group and in 7 of 572 (1.2%) patients in the warfarin group (P = 1.0). ALL patients who had a pericardia l. tamponade, including 2 in the dabigatran group, had uneventful recovery after perdicardiocentesis. On multivariate analysis, international. normalized ratio (odds ratio [OR] 4.0; 95% confidence interval. [CI] 1.1-15.0; P = .04), clopidogrel use (OR 4.2; 95% CI 1.5-12.3; P = .01), and CHA(2)DS(2)-VASc score (OR 1.4; 95% CI 1.1-1.8; P = .01) were the independent risk factors of breeding complications only in the warfarin group. CONCLUSIONS When herd for approximately 24 hours before the procedure and resumed 4 hours after vascular hemostasis, dabigatran appears to be as safe and effective as uninterrupted warfarin for periprocedural anticoagulation in patients undergoing RFA of AF.

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