Use of Dabigatran Immediately After AF Ablation
Use of Dabigatran Immediately After AF Ablation
Dabigatran After AF Ablation.
Introduction: Atrial fibrillation (AF) ablation requires postprocedural anticoagulation to prevent thromboembolic events because of the ablation procedure itself or due to recurrent AF postprocedure. Dabigatran is a new anticoagulant and may be useful after AF ablation to prevent thromboembolic events.
Methods and Results: We evaluated 123 consecutive patients who were started on dabigatran after AF ablation. Patients were given enoxaparin 0.5 mg/kg at the end of the procedure, which was repeated 12 hours later and then discontinued. Dabigatran was started 22 hours postablation with drug dose based on renal function. Primary outcomes were thromboembolic events, bleeding complications, and side effects over a 30-day follow-up period.
The preablation anticoagulant was warfarin in 56 (45.5%) patients, dabigatran in 34 (27.6%), and aspirin in 26 (21.1%). Seven (5.7%) patients were on no anticoagulant before ablation. The patients on dabigatran before ablation with normal renal function had the drug stopped 36 hours preablation. There were no preprocedural or intraprocedural thromboembolic episodes or bleeding. Three patients received dabigatran 75 mg bid and the rest 150 mg bid. There were no postablation strokes, transient ischemic attacks, or systemic thromboemboli in any patient. Three patients discontinued dabigatran and were changed to warfarin, 2 because of gastrointestinal side effects and 1 because of a diffuse rash.
Conclusions: Dabigatran is safe and well tolerated after AF ablation. It did not cause bleeding complications and there were no thromboembolic events. Dabigatran appears to be an alternative to warfarin after AF ablation
Anticoagulation strategy is an important component of atrial fibrillation (AF) treatment strategy, especially for AF ablation procedures. Anticoagulation strategy must be considered for the preablation, intraprocedural, and postablation periods. Preablation anticoagulation decisions are generally guided by stroke risk estimated by clinical prediction rules such as the CHADS2 score or the CHA2DS2-VASc score, which recommend either aspirin or warfarin anticoagulation. Preprocedural anticoagulation strategies vary considerably. Some centers start warfarin 30 days before AF ablation in all patients regardless of stroke risk with enoxaparin bridging, some centers stop warfarin before ablation for those patients already on the drug and use enoxaparin bridging, and some continue warfarin throughout and after the ablation. Virtually all anticoagulation strategies use intraprocedural systemic unfractionated heparin guided by activated clotting time (ACT) levels. Initially, ACT targets were >300–350 seconds; however, more recently, with the use of open irrigated tip ablation catheters, a target ACT of 225 has been shown to be safe and to reduce bleeding complications without increasing stroke or other thromboembolic risks. Until dabigatran became available, most postablation anticoagulation strategies used warfain with a target international normalized ratio of 2.0–3.0.
The recent introduction of dabigatran, an oral direct thrombin inhibitor, has provided a new option for pre- and post-AF ablation anticoagulation. This study reports our experience with dabigatran anticoagulation before and after AF ablation with regard to drug tolerance, bleeding, and thromboembolic events.
Abstract and Introduction
Abstract
Dabigatran After AF Ablation.
Introduction: Atrial fibrillation (AF) ablation requires postprocedural anticoagulation to prevent thromboembolic events because of the ablation procedure itself or due to recurrent AF postprocedure. Dabigatran is a new anticoagulant and may be useful after AF ablation to prevent thromboembolic events.
Methods and Results: We evaluated 123 consecutive patients who were started on dabigatran after AF ablation. Patients were given enoxaparin 0.5 mg/kg at the end of the procedure, which was repeated 12 hours later and then discontinued. Dabigatran was started 22 hours postablation with drug dose based on renal function. Primary outcomes were thromboembolic events, bleeding complications, and side effects over a 30-day follow-up period.
The preablation anticoagulant was warfarin in 56 (45.5%) patients, dabigatran in 34 (27.6%), and aspirin in 26 (21.1%). Seven (5.7%) patients were on no anticoagulant before ablation. The patients on dabigatran before ablation with normal renal function had the drug stopped 36 hours preablation. There were no preprocedural or intraprocedural thromboembolic episodes or bleeding. Three patients received dabigatran 75 mg bid and the rest 150 mg bid. There were no postablation strokes, transient ischemic attacks, or systemic thromboemboli in any patient. Three patients discontinued dabigatran and were changed to warfarin, 2 because of gastrointestinal side effects and 1 because of a diffuse rash.
Conclusions: Dabigatran is safe and well tolerated after AF ablation. It did not cause bleeding complications and there were no thromboembolic events. Dabigatran appears to be an alternative to warfarin after AF ablation
Introduction
Anticoagulation strategy is an important component of atrial fibrillation (AF) treatment strategy, especially for AF ablation procedures. Anticoagulation strategy must be considered for the preablation, intraprocedural, and postablation periods. Preablation anticoagulation decisions are generally guided by stroke risk estimated by clinical prediction rules such as the CHADS2 score or the CHA2DS2-VASc score, which recommend either aspirin or warfarin anticoagulation. Preprocedural anticoagulation strategies vary considerably. Some centers start warfarin 30 days before AF ablation in all patients regardless of stroke risk with enoxaparin bridging, some centers stop warfarin before ablation for those patients already on the drug and use enoxaparin bridging, and some continue warfarin throughout and after the ablation. Virtually all anticoagulation strategies use intraprocedural systemic unfractionated heparin guided by activated clotting time (ACT) levels. Initially, ACT targets were >300–350 seconds; however, more recently, with the use of open irrigated tip ablation catheters, a target ACT of 225 has been shown to be safe and to reduce bleeding complications without increasing stroke or other thromboembolic risks. Until dabigatran became available, most postablation anticoagulation strategies used warfain with a target international normalized ratio of 2.0–3.0.
The recent introduction of dabigatran, an oral direct thrombin inhibitor, has provided a new option for pre- and post-AF ablation anticoagulation. This study reports our experience with dabigatran anticoagulation before and after AF ablation with regard to drug tolerance, bleeding, and thromboembolic events.