This work is not supported by any external funding.
A Randomized Controlled Trial of Dabigatran versus Warfarin for Periablation Anticoagulation in Patients Undergoing Ablation of Atrial Fibrillation
Version of Record online: 4 NOV 2012
©2012, The Authors. Journal compilation ©2012 Wiley Periodicals, Inc.
Pacing and Clinical Electrophysiology
Volume 36, Issue 2, pages 172–179, February 2013
How to Cite
NIN, T., SAIRAKU, A., YOSHIDA, Y., KAMIYA, H., TATEMATSU, Y., NANASATO, M., INDEN, Y., HIRAYAMA, H. and MUROHARA, T. (2013), A Randomized Controlled Trial of Dabigatran versus Warfarin for Periablation Anticoagulation in Patients Undergoing Ablation of Atrial Fibrillation. Pacing and Clinical Electrophysiology, 36: 172–179. doi: 10.1111/pace.12036
- Issue online: 4 FEB 2013
- Version of Record online: 4 NOV 2012
- Manuscript Revised: 5 SEP 2012
- Manuscript Accepted: 5 SEP 2012
- Manuscript Received: 10 JUN 2012
- atrial fibrillation;
- periablation anticoagulation;
- time to ablation
We aimed to evaluate the feasibility of an oral direct thrombin inhibitor, dabigatran, as a periprocedural anticoagulant for use with ablation of atrial fibrillation (AF).
Consecutive patients scheduled to undergo an AF ablation were randomly assigned to receive dabigatran (n = 45) or warfarin (n = 45) to compare their clinical feasibility. Both of those oral anticoagulants were discontinued the day before the ablation and were resumed after confirming hemostasis of the venipuncture site. A bridging therapy with heparin was not used in either of the patient groups.
Dabigatran was switched to warfarin before the ablation because of dyspepsia in three patients. An occurrence of rebleeding from the venipuncture site was less common in dabigatran-allocated patients than in warfarin-allocated patients (20% vs 44%; P = 0.013). The reduction in the D-dimer level after the initiation of oral anticoagulants was greater in the dabigatran-allocated patients than in the warfarin-allocated patients. The time from the initiation of the anticoagulants to the ablation was significantly shorter in the dabigatran-allocated patients than in the warfarin-allocated patients (43 ± 7 vs 63 ± 13 days; P < 0.0001). There was only one fatal periprocedural complication in a patient receiving warfarin, who had a mesenteric arterial thrombosis after the ablation.
An anticoagulation strategy with dabigatran may surpass that with warfarin in reducing both the periprocedural risk of minor bleeding and a hypercoagulable state, and the time to ablation in patients undergoing ablation of AF.