Is Uninterrupted Dabigatran Safe for Patients Undergoing Ablation for AF?

Anticoagulation with uninterrupted dabigatran is associated with less risk of bleeding complications than uninterrupted warfarin in patients undergoing ablation for atrial fibrillation (AF), according to a recent study.

While catheter ablation is usually performed with uninterrupted anticoagulation with warfarin or with interrupted non-vitamin K antagonist oral anticoagulant therapy, researchers hypothesized that uninterrupted anticoagulation therapy with a non-vitamin K antagonist could be a safer option.
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The researchers conducted a randomized, open-label, multicenter, controlled trial with blinded adjudicated endo-point assessments in which 704 participants who were scheduled for catheter ablation were randomly assigned to either dabigatran (150 mg twice daily) or warfarin (target international normalized ratio, 2.0 to 3.0). After 4 to 8 weeks of uninterrupted anticoagulation, ablation was performed. Anticoagulation was continued for 8 weeks after ablation.

Overall, the incidence of major bleeding during ablation and up to 8 weeks after was lower in the participants given dabigatran than in those given warfarin (1.6% vs 6.9%). Dabigatran was also associated with fewer periprocedural pericardial tamponades and groin hematomas, compared with warfarin.

“In patients undergoing ablation for atrial fibrillation, anticoagulation with uninterrupted dabigatran was associated with fewer bleeding complications than uninterrupted warfarin,” the researchers concluded.

—Michael Potts

Reference:

Calkins H, Willems S, Gerstenfeld EP, et al. Uninterrupted dabigatran versus warfarin for ablation in atrial fibrillation [published online April 27, 2017]. doi:10.1056/NEJMoa1701005.