Dabigatran Safe and Effective Post-Atrial Fibrillation Ablation

SAN FRANCISCO, CA—At ACC.13, the American College of Cardiology's 62nd Annual Scientific Session, leading cardiologists presented that the use of dabigatran following ablation for atrial fibrillation resulted in no major post-procedural complications.

Post-procedure anticoagulation therapy is administered to patients undergoing atrial fibrillation ablation to prevent thromboembolism. Dabigatran is an alternative treatment to low molecular weight heparin (LMWH) plus warfarin, but its safety and efficacy post-atrial fibrillation ablation (AFabl) has been debated. Many centers discontinue a patient's warfarin therapy prior to the procedure and bridge with LMWH immediately after the ablation until a therapeutic INR is achieved on warfarin.

Sharon Shen, MD, from Northwestern University, Feinberg School of Medicine, Chicago, IL, and researchers hypothesized that post-procedural dabigatran leads to lower rates of bleeding and thromboembolic complications compared to LMWH plus warfarin.

The team performed a single-center study of consecutive patients who underwent AFabl between January 2010 and May 2012, and received post-procedure LMWH plus warfarin or dabigatran.  Warfarin was started the night of AFabl, LMWH the next morning to an INR >2, and dabigatran was started the morning post-AFabl. Primary outcomes of the study were composite of thromboembolism, bleeding, and death at 30 days.

Out of the 278 patients total who met the inclusion criteria, 142 (51%) received dabigatran and 136 (49%) received warfarin. At 30-days post-procedure, there were no (0%) thromboembolic or bleeding complications in the dabigatran group vs. four (2.9%) in the warfarin group. One required transfusion, one cerebrovascular accident or transient ischemic attack, and two hematomas (P=0.056). Both groups had no incidence regarding 30-day mortality.

It was concluded that dabigatran posed no major anticoagulant-related complications at 30 days post-procedure and approached a statistically significant advantage vs. LMWH plus warfarin. Dr. Shen concluded stated, “Larger studies are needed to confirm these findings, but dabigatran appears safe and effective following AFabl.”