Feasibility and Safety of Dabigatran Versus Warfarin for Periprocedural Anticoagulation in Patients Undergoing Radiofrequency Ablation for Atrial Fibrillation

Lakkireddy, Dhanunjaya; Reddy, Yeruva Madhu; Biase, Luigi Di; Vanga, Subba Reddy; Santangeli, Pasquale; Swarup, Vijay; Pimentel, Rhea; Mansour, Moussa; d’Ávila, André; Sánchez, Javier; Burkhardt, J. David; Chalhoub, Fadi; Mohanty, Prasant; Coffey, James O.; Shaik, Naushad; Monir, George; Reddy, Vivek Y.; Ruskin, Jeremy N.; Natale, Andrea

doi:10.1016/j.jacc.2011.12.014

Cited by 287 publications

(205 citation statements)

References 32 publications

Supporting

Mentioning

185

Contrasting

Unclassified

Order By: Relevance

“…Data comparing uninterrupted dabigatran versus warfarin have shown contrasting results and have included mainly paroxysmal AF patients [6][7][8][9][10][11]. When non-paroxysmal AF patients have been included, uninterrupted dabigatran use seemed to be inferior when compared to the uninterrupted warfarin use in protecting against TIA/stroke [12,13].…”

mentioning

confidence: 99%

Safety and efficacy of novel oral anticoagulants in the setting of atrial fibrillation ablation: Is it time to celebrate the “funeral” of warfarin?

Biase

2014

J Interv Card Electrophysiol

Self Cite

View full text Add to dashboard Cite

mentioning

confidence: 99%

Safety and efficacy of novel oral anticoagulants in the setting of atrial fibrillation ablation: Is it time to celebrate the “funeral” of warfarin?

Biase

2014

J Interv Card Electrophysiol

Self Cite

View full text Add to dashboard Cite

“…Lakkireddy et al discontinued dabigatran on the morning of the procedure. 5 In other words, AF procedures were performed within approximately 1.5-fold of the elimination half-life, suggesting a significant residual pharmacodynamic effect. In this regard, Winkle et al 6 recently demonstrated that periprocedural use of dabigatran caused no bleeding and thromboembolic complications until 30 days after the procedure.…”

Section: Article P 2337mentioning

confidence: 99%

“…In patients whose eGFR was <40 ml · min -1 · 1.73 m −2 , it was stopped 60 h before ablation. Thus, when compared with the study by Lakkireddy et al, 5 Winkle et al discontinued dabigatran earlier before the ablation procedure. 6 The target range of the activated clotting time (ACT) during the ablation procedure is another important factor.…”

Section: Article P 2337mentioning

confidence: 99%

“…Thus, their study was not one that demonstrates the superiority of dabigatran over warfarin. 4In contrast, important results from a multicenter prospective registry comparing the feasibility and safety of dabigatran with uninterrupted warfarin have been reported by Lakkireddy et al 5 In their analysis comparing 145 patients on uninterrupted warfarin with 145 patients taking dabigatran, the latter group had a significantly higher rate of major bleeding complications (9 patients, 6%), all of which were pericardial tamponade requiring drainage. Major bleeding (pericardial tamponade) was observed in only one patient (1%) in the warfarin group.…”

mentioning

confidence: 96%

“…Based on these observations, Lakkireddy et al concluded that in patients undergoing AF ablation, continuation of dabigatran during the periprocedural period is associated with an increased risk of bleeding and a composite of bleeding or embolic complications compared with uninterrupted warfarin therapy. 5 Why do these 2 studies 4,5 showed distinctly different results? We should firstly review the pharmacologic characteristics of dabigatran.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Can Dabigatran Be an Alternative Periprocedural Anticoagulation for Atrial Fibrillation Ablation?

Takahashi¹

2012

Circ J

View full text Add to dashboard Cite

Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp he number of patients undergoing catheter ablation for atrial fibrillation (AF) has been increasing year by year. As noted in the updated guideline (ACC/AHA/ ESC) for the management of patients with AF, 1 embolic stroke is one of the most serious complications of AF ablation procedures. A higher intensity of anticoagulation is required to reduce the risk of thrombus formation during ablation. The recent 2012 HRS/EHRA/ECAS expert consensus statement notes that uninterrupted warfarin is a potential alternative to bridging with low-molecular-weight heparin. 2 In fact, in Japan, most of the large-volume centers adopt continuation of periprocedural warfarin in the therapeutic range. However, warfarin takes a long time to reach to its therapeutic range and there are some patients in whom it is difficult to control warfarin within the therapeutic range. Dabigatran, an oral direct thrombin inhibitor, was recently approved for the prevention of embolic stroke in patients with nonvalvular AF. 3 Therefore, there has been an interest in taking advantage of dabigatran around the time of catheter ablation. Three reports that evaluated the safety of periprocedural use of dabigatran for AF ablation in comparison with warfarin have been recently published. 4-6 Article p 2337In this issue of the Journal, Kaseno et al 4 demonstrate that dabigatran at a dose of 110 mg twice daily was safe in AF ablation. In their study, 110 patients treated with dabigatran developed no symptomatic thromboembolic complications. No patients had pericardial tamponade, and minor bleeding was observed in only 5 patients. These observations suggest that dabigatran could be a safe alternative strategy. However, caution is needed when interpreting this study. First of all, as the authors acknowledge, up to 92% of the patients had a CHADS2 score of 1 or 0, indicating essentially low risk for both thromboembolic and bleeding complications. Together with the fact that the authors' center is one of the largest-volume centers in Japan, with many experts for AF ablation, the observations cannot be wholly applicable to general AF ablation performed in medium-and low-volume centers. In addition, their study was retrospective and there was significant background inequality between the dabigatran and warfarin groups. For example, age was younger and left atrial dimension smaller in the dabigatran group. The number of patients having persistent AF was lower in the dabigatran group. Thus, their study was not one that demonstrates the superiority of dabigatran over warfarin. 4In contrast, important results from a multicenter prospective registry comparing the feasibility and safety of dabigatran with uninterrupted warfarin have been reported by Lakkireddy et al. 5 In their analysis comparing 145 patients on uninterrupted warfarin with 145 patients taking dabigatran, the latter group had a significantly higher rate of major bleeding complications (9 patients, 6%), all of wh...

show abstract

Safety and Efficacy of Minimally Interrupted Dabigatran vs Uninterrupted Warfarin Therapy in Adults Undergoing Atrial Fibrillation Catheter Ablation

et al. 2019

View full text Add to dashboard Cite

IMPORTANCE Uninterrupted dabigatran therapy reduces stroke risk in patients with nonvalvular atrial fibrillation (NVAF) undergoing ablation and is associated with a lower bleeding risk than uninterrupted warfarin therapy. Minimally interrupted direct oral anticoagulant therapy is widely used, but data from controlled studies are insufficient. OBJECTIVE To compare the safety and efficacy of minimally interrupted dabigatran vs uninterrupted warfarin therapy in patients undergoing catheter ablation for NVAF. DESIGN, SETTING, AND PARTICIPANTS The ABRIDGE-J (ABlation peRIoperative DabiGatran in use Envisioning in Japan) trial is a open-label, randomized clinical trial performed in 28 Japanese treatment centers. A total of 504 patients scheduled for NVAF ablation were enrolled; 500 were randomized to the study treatments; 499 received at least 1 dose of dabigatran etexilate (n = 248) or warfarin potassium (n = 251); and 442 underwent ablation (220 in the dabigatran group and 222 in the warfarin group).

show abstract

Feasibility and Safety of Dabigatran Versus Warfarin for Periprocedural Anticoagulation in Patients Undergoing Radiofrequency Ablation for Atrial Fibrillation

Abstract: In patients undergoing AF ablation, periprocedural dabigatran use significantly increases the risk of bleeding or thromboembolic complications compared with uninterrupted warfarin therapy.

Cited by 287 publications

References 32 publications

Safety and efficacy of novel oral anticoagulants in the setting of atrial fibrillation ablation: Is it time to celebrate the “funeral” of warfarin?

Safety and efficacy of novel oral anticoagulants in the setting of atrial fibrillation ablation: Is it time to celebrate the “funeral” of warfarin?

Can Dabigatran Be an Alternative Periprocedural Anticoagulation for Atrial Fibrillation Ablation?

Safety and Efficacy of Minimally Interrupted Dabigatran vs Uninterrupted Warfarin Therapy in Adults Undergoing Atrial Fibrillation Catheter Ablation

Contact Info

Product

Resources

About