February 2nd, 2012

Study Explores Role of Periprocedural Dabigatran in AF Ablation

As dabigatran becomes more widely used in AF patients, electrophysiologists are trying to figure out how to handle anticoagulation in patients taking the drug and for whom AF ablation is planned. In a new study published in the Journal of the American College of Cardiology, Dhanunjaya Lakkireddy and colleagues report on a multicenter, observational study of 290 patients who underwent an AF ablation procedure. Half the patients were taking periprocedural dabigatran and half were matched controls taking warfarin.

There were significantly more thromboembolic  and bleeding complications in the dabigatran group than in the warfarin group:

  • Thromboembolic complications: 3 with dabigatran versus none with warfarin (p=0.25)
  • Major bleeding complications: 9 versus 1 (p=0.019)
  • Composite of bleeding and thromboembolic complications: 16% versus 6% (p = 0.009)

In a multivariate analysis, dabigatran was an independent predictor of bleeding or thromboembolic complications (OR 2.76, CI 1.22 – 6.25; p = 0.01).

In an editorial comment, Bradley Knight writes that the study “at first… appears to suggest that dabigatran has no role periprocedurally in patients undergoing AF ablation.” Although “AF ablation should not be performed on nearly uninterrupted dabigatran, as it was used in this study,” Knight preserves hope for “other approaches that capitalize on the advantages of the new oral anticoagulants.”

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