Comparison of uninterrupted anticoagulation with dabigatran etexilate or warfarin in the periprocedural period for atrial fibrillation catheter ablation: Results of the Japanese subgroup of the RE‐CIRCUIT trial

Abstract

BackgroundThere are limited data on uninterrupted anticoagulation with direct oral anticoagulants during catheter ablation for atrial fibrillation (AF), particularly in Japan. We planned a subgroup analysis of the RE‐CIRCUIT study, comparing the use of uninterrupted dabigatran therapy with warfarin therapy during catheter ablation among the Japanese subgroup and with that in the total population.MethodsThe RE‐CIRCUIT study utilized a prospective, randomized, open‐label, blinded endpoint design, and the primary endpoint was the incidence of major bleeding events (MBEs). Patients were randomized to uninterrupted dabigatran 150 mg twice daily or warfarin. In this study, we analyzed the results in Japanese patients.ResultsOf 704 enrolled patients in the study, 112 Japanese patients were randomized to dabigatran (n = 65) or warfarin (n = 47). MBEs were experienced by two patients: one in the dabigatran group (1.6%, cardiac tamponade) and one in the warfarin group (2.2%, groin hematoma) (risk difference vs warfarin −0.6%; 95% CI −5.8, 4.7). Within the Japanese subgroup, there were no thromboembolic events in both groups.ConclusionWhile not designed to show statistical difference between two treatment groups, our results from the Japanese subgroup supported those from the overall population. Furthermore, this study provided clinical information regarding MBE, especially cardiac tamponade, in Japanese patients.

Feasibility of Uninterrupted Direct Oral Anticoagulants with Temporary Switching to Dabigatran ("Dabigatran Bridge") for Catheter Ablation of Atrial Fibrillation

“…First, AF ablation can be performed under an uninterrupted dabigatran therapy. The RE-CIRCUIT trial showed that uninterrupted dabigatran was associated with fewer bleeding complications than uninterrupted war-farin, 11,12) and dabigatran is the only DOAC superior to warfarin with respect to procedural safety. The mechanisms may be related to the specific mechanism of action (direct thrombin inhibition rather than a Xa inhibitor).…”

Editorial to “Safety and Efficacy of Uninterrupted Treatment with Edoxaban or Warfarin During the Peri‐Procedural Period of Catheter Ablation for Atrial Fibrillation”

“…Besides, after the launch of direct oral anticoagulants (DOACs), several randomized control studies to evaluate the safety of uninterrupted DOACs during the procedure were performed: that is, the VENTURE‐AF (rivaroxaban), RE‐CIRCUIT (dabigatran), AXAFA‐AFNET5 (apixaban), and ELIMINATE‐AF 2 (edoxaban) trials. However, since only the RE‐CIRCUIT included Japanese patients, 3 the actual data for Japanese patients has been lacking.…”