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Dabigatran versus Warfarin Therapy for Uninterrupted Oral Anticoagulation During Atrial Fibrillation Ablation

Authors

  • WILLIAM MADDOX M.D.,

    1. Division of Cardiology, Department of Medicine, Georgia Regents University, Augusta, Georgia, USA
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  • G. NEAL KAY M.D.,

    1. Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
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  • TAKUMI YAMADA M.D., Ph.D.,

    1. Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
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  • JOSE OSORIO M.D.,

    1. Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
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  • HARISH DOPPALAPUDI M.D.,

    1. Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
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  • VANCE J. PLUMB M.D.,

    1. Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
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  • ALICIA GUNTER A.A.,

    1. Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
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  • H. THOMAS MCELDERRY M.D.

    Corresponding author
    1. Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
    • Division of Cardiology, Department of Medicine, Georgia Regents University, Augusta, Georgia, USA
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  • Dr. McElderry reports doing consulting, speaking and research for Biosense Webster, Boston Scientific, St. Jude Medical, VytronUS, and Voyage Medical. Other authors: No disclosures.

Address for correspondence: H. Thomas McElderry, M.D., 930 Faculty Office Tower, University of Alabama at Birmingham, Birmingham, AL 35294, USA. Fax: +205-996-7460; E-mail: tommcelderry@uab.edu

Dabigatran versus Warfarin for AF Ablation

Background

Uninterrupted oral anticoagulant (OA) therapy with warfarin has become the standard of care at many centers performing catheter ablation of atrial fibrillation (AF). Compared with warfarin, dabigatran, a direct thrombin inhibitor, has been demonstrated to reduce the risk of stroke in nonvalvular AF with similar bleeding risk. Few data exist on the safety profile of uninterrupted dabigatran therapy during AF ablation.

Methods

We compared the safety and efficacy of uninterrupted OA therapy with either warfarin or dabigatran in all patients undergoing AF catheter ablation at the University of Alabama at Birmingham between November 1, 2010 and January 31, 2012. All patients underwent a transesophageal echocardiogram (TEE) on the day of their ablation procedure to assess for the presence of intracardiac thrombi. All complications were identified and classified as bleeding, thromboembolic events, or other.

Results

There were 212 patients in the dabigatran group and 251 patients in the warfarin group. The groups were well matched. There were 3 complications in the dabigatran group and 6 in the warfarin group (P = 0.45). There were 2 bleeding complications in the dabigatran group and 6 in the warfarin group (P = 0.23). There was one thromboembolic complication (a possible TIA) in the dabigatran group and none in the warfarin group (P = 0.28).

Conclusion

The administration of dabigatran is as safe and effective as warfarin for uninterrupted OA therapy during catheter ablation of AF.

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