Purpose: Patients
undergoing catheter ablation for atrial fibrillation (AF) are at a higher risk
of thromboembolic events post-procedure and therefore require therapeutic
anticoagulation after ablation. Anticoagulation strategies include performing
the procedure on or off therapeutic warfarin, though the latter approach
requires post-procedure bridging therapy with low molecular-weight heparin
(LMWH) until a therapeutic INR is achieved. The purpose of this
study is to compare the safety and efficacy of post-ablation dabigatran as
compared to warfarin with LMWH bridging.
Methods: We
performed a single-center retrospective analysis of consecutive patients who
underwent catheter ablation for AF between January 2010 and December 2012 and
received either post-procedure warfarin with a LMWH bridge or dabigatran.
Warfarin was started the night of ablation; LMWH was started the next morning
and continued until the INR was ≥ 2.0. Dabigatran was started the morning
post-ablation.
Results: The
analysis included 324 patients. Of these, mean age was 60 ± 9 years,
78% were male, 81% had CHADS2 scores of 0 or 1, and 181 (56%)
received dabigatran post-ablation. Patients who received dabigatran had lower
CHADS2 scores and were more likely to be in NYHA Class I. At
30-days post-procedure, there were 0 thromboembolic or bleeding complications
in the dabigatran group versus 4 (2.8%) in the warfarin group (p=0.037). There
were no deaths in either group at 30 days post-ablation.
Conclusions: Post-ablation
dabigatran appears safe and efficacious compared to an interrupted warfarin
strategy with LMWH bridging.
Credits: Jeffrey Lin, MD; Sharon Shen, MD; Prashant Bhave, MD; Bradley Knight, MD; Martha Bohn, RN, BSN; Evaldas Giedrimas, MD; Taral K. Patel, MD; Alexandru Chicos, MD; Jeffrey Goldberger, MD; Leonard Ilkhanoff, MD, MS; Susan Kim, MD; Albert Lin, MD; Rod Passman, MD, MSCE.
