Low dose dabigatran versus uninterrupted acenocoumarol for peri-procedural anticoagulation in atrial fibrillation catheter ablation.

Abstract

BACKGROUND:

Left atrial ablation for atrial fibrillation (AF) is associated with a transiently increased risk of thromboembolic and hemorrhagic events. We tested the hypothesis that the low dose dabigatran [110mg twice a day (bid)] can be safely used as an alternative to uninterrupted acenocoumarol for periprocedural anticoagulation in left atrial ablation procedures.

METHODS AND RESULTS:

A total of 149 consecutive patients undergoing pulmonary vein antral isolation for AF were included; 64 patients were on low dose dabigatran (110mg bid) and 85 patients were on acenocoumarol with therapeutic international normalized ratios. Two doses of dabigatran were withheld before the procedure and the drug was restarted 4hours after vascular hemostasis. Overall, the two groups were well-matched. Hemorrhagic and thromboembolic complications were similar in both groups within 90days from the procedure (4.7% for the dabigatran group versus 9.4% for the acenocoumarol group; P=0.275). Major hemorrhage occurred in 1.6% in the dabigatran group versus 3.5% in the acenocoumarol group (P=0.462). A single thromboembolic event occurred in the dabigatran group (1.6%) versus 2 (2.4%) in the acenocoumarol group (P=0.734). Despite higher doses of intraprocedural heparin (P<0.01), the mean activated clotting time was significantly lower in patients who were on dabigatran than those on acenocoumarol (P<0.01).

CONCLUSIONS:

The low dose dabigatran regimen provides safe and effective peri-procedural anticoagulation in patients undergoing left atrial ablation for AF compared with uninterrupted acenocoumarol therapy.

• Authors: Michael Efremidis, Konstantinos Vlachos, Konstantinos P Letsas, Georgios Giannopoulos, Louiza Lioni, Stamatis Georgopoulos, Maria Vadiaka, Spyridon Deftereos, Antonios Sideris
• Journal: Journal of electrocardiology (J Electrocardiol) 2015 Sep-Oct Vol. 48 Issue 5 Pg. 840-4 ISSN: 1532-8430 [Electronic] United States
• PMID: 26152604 (Publication Type: Controlled Clinical Trial, Journal Article)
• Copyright: Copyright © 2015 Elsevier Inc. All rights reserved.

Chemical References

• Anticoagulants
• Dabigatran
• Acenocoumarol

Topics

• Acenocoumarol (administration & dosage, adverse effects)
• Anticoagulants (administration & dosage, adverse effects)
• Atrial Fibrillation (drug therapy, surgery)
• Catheter Ablation (adverse effects, methods)
• Dabigatran (administration & dosage, adverse effects)
• Dose-Response Relationship, Drug
• Drug Administration Schedule
• Female
• Humans
• Male
• Middle Aged
• Postoperative Hemorrhage (chemically induced, prevention & control)
• Premedication (methods)
• Thrombosis (etiology, prevention & control)
• Treatment Outcome