Abstract
Introduction
Although warfarin has traditionally been used for reducing risk of stroke in patients with atrial fibrillation, over the past year, the direct thrombin inhibitor dabigatran has become an accepted alternative. No study has conclusively investigated bleeding risks of patients treated with dabigatran immediately following radiofrequency catheter ablation (RFCA) procedures.
Methods
We evaluated 156 consecutive patients referred for RFCA of atrial arrhythmias: 31 patients were on dabigatran and 125 patients were on warfarin. The incidence of bleeding complications during the first 48 h and the first week following ablation were recorded and comparisons made using Fisher's exact test. Major complications were defined as hemorrhage requiring blood products or the need for vascular intervention. Minor complications were defined as prolonged bleeding from the catheter insertion site, hematoma formation, or development of ecchymosis. Our study also took into account the intraprocedure activated clotting time (ACT) levels in an effort to describe any differences between both patient groups.
Results
There were no differences in age, gender, procedure type, or level of intraprocedural anticoagulation between the warfarin and dabigatran groups. No major bleeding complications were observed in either patient group at either 48 h or 1 week postprocedure. Six of the 31 dabigatran patients and 21 of the 125 warfarin patients had minor bleeding complications. There was no statistically significant difference between the incidence of minor bleeding complications between the two groups (p = 0.7384), although rebleeding was more commonly observed in patients on dabigatran. In regard to the intraprocedure ACT levels, there was more variability in the dabigatran patient group, and it was more difficult to achieve the goal ACT level, yet these results did not affect overall bleeding complications.
Conclusion
In our cohort, bleeding-related complications 48 h and 1 week post-ablation were similar for warfarin and dabigatran. Dabigatran is associated with more intraprocedural variability in ACT than warfarin.
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Editorial Commentary
This retrospective study reports on the rate of bleeding complication occurring after catheter ablation of atrial fibrillation in 125 patients treated with warfarin versus 31 patients treated with dabigatran. No major bleeding complications occurred in either group. There was one procedural-related pericardial effusion in each group, and no embolic events were noted in the study. The dabigatran group had more intraprocedure ACT variability. This paper adds to the literature related to the use of dabigatran in patients with atrial fibrillation undergoing catheter ablation procedures.
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Snipelisky, D., Kauffman, C., Prussak, K. et al. A comparison of bleeding complications post-ablation between warfarin and dabigatran. J Interv Card Electrophysiol 35, 29–33 (2012). https://doi.org/10.1007/s10840-012-9708-z
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DOI: https://doi.org/10.1007/s10840-012-9708-z