Dabigatran vs warfarin for radiofrequency catheter ablation of atrial fibrillation

作者：Kim Jin Seok; She Fei; Jongnarangsin Krit; Chugh Aman; Latchamsetty Rakesh; Ghanbari Hamid; Crawford Thomas; Suwanagool Arisara; Sinno Mohammed; Carrigan Thomas; Kennedy Robert; Saint Phard Wouter; Yokokawa Miki; Good Eric; Bogun Frank; Pelosi Frank Jr; Morady Fred; Oral Hakan^*

来源：Heart Rhythm, 2013, 10(4): 483-489.

DOI：10.1016/j.hrthm.2012.12.011

• Atrial fibrillation
• Catheter ablation
• Warfarin
• Dabigatran
• Bleeding

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.

• 出版日期2013-4