Author + information
- Jeffrey Lin,
- Bradley Knight,
- Prashant Bhave,
- Martha Bohn,
- Alexandru Chicos,
- Evaldas Giedrimas,
- Jeffrey Goldberger,
- Leonard Ilkhanoff,
- Susan Kim,
- Albert Lin,
- Taral Patel,
- Sharon Shen and
- Rod Passman
Patients undergoing atrial fibrillation ablation (AFabl) receive post-procedure anticoagulation (AC) to prevent thromboembolism. Dabigatran is an alternative to low molecular weight heparin (LMWH) plus warfarin, but its safety and efficacy post-AFabl is controversial.
We performed a single-center study of consecutive patients who underwent AFabl between January 2010 and May 2012 and received either post-procedure LMWH plus warfarin or dabigatran. Warfarin was started the night of AFabl and LMWH the next morning to an INR > 2. Dabigatran was started the morning post-AFabl. The primary outcome was a composite of thromboembolism, bleeding, and death at 30-days.
Of 285 patients, 7 were excluded for receiving an alternative agent or no post-procedure AC. Of the remaining 278 patients, 78% were male, age 60.1 ± 9.5 years, 81% with CHADS2 scores of 0 or 1, and 142 (51%) received dabigatran. Characteristics are listed in Table. Patients who received dabigatran had lower CHADS2 scores, were more likely to be in NYHA Class I, and were less likely to be diabetic. At 30-days post-procedure, there were no (0%) thromboembolic or bleeding complications in the dabigatran group versus four (2.9%) in the warfarin group (one stroke, three bleeds), (p= 0.056). 30-day mortality in both groups was 0.
The use of dabigatran following AFabl resulted in no major post-procedural complications. Though larger studies are needed, dabigatran appears safe and effective following AFabl.
|Characteristics||Dabigatran (n=142)||Warfarin (n=136)||p Value|
|Gender (Male)||116 (81.7%)||102 (75%)||0.175|
|Age (years)||60.3 ± 9.2||60.0 ± 9.9||0.796|
|Hypertension||57 (40.1%)||67 (49.3%)||0.168|
|Diabetes||12 (8.5%)||22 (16.2%)||0.049|
|Creatinine (mg/dl)||1.06 ±. 24||1.07 ±. 34||0.705|
|Paroxysmal AF||104 (73.2%)||91 (66.9%)||0.144|
|CHADS2 0–1||125 (88.0%)||101 (74.3%)||0.012|
|NYHA Class I||134 (97.1%)||110 (84.0%)||<0.001|
|Ejection Fraction (%)||57.5 ± 7.9||56.3 ± 11.4||0.423|
Poster Sessions, Expo North
Saturday, March 09, 2013, 10:00 a.m.-10:45 a.m.
Session Title: Arrhythmias: AF/SVT II
Abstract Category: 4. Arrhythmias: AF/SVT
Presentation Number: 1107-49
- 2013 American College of Cardiology Foundation