Uninterrupted Dabigatran versus Warfarin for Ablation in Atrial Fibrillation

• Published in: The New England journal of medicine Vol. 376; no. 17; pp. 1627 - 1636
• Main Authors: Calkins, Hugh, Willems, Stephan, Gerstenfeld, Edward P, Verma, Atul, Schilling, Richard, Hohnloser, Stefan H, Okumura, Ken, Serota, Harvey, Nordaby, Matias, Guiver, Kelly, Biss, Branislav, Brouwer, Marc A, Grimaldi, Massimo
• Format: Journal Article
• Language: English
• Published: United States Massachusetts Medical Society 27.04.2017
• Subjects: Ablation; Aged; Anticoagulants; Anticoagulants - administration & dosage; Anticoagulants - adverse effects; Atrial Fibrillation - drug therapy; Atrial Fibrillation - surgery; Bleeding; Cardiac arrhythmia; Catheter Ablation; Catheters; Dabigatran - administration & dosage; Dabigatran - adverse effects; Female; Fibrillation; Hematoma; Hemorrhage - chemically induced; Hemorrhage - epidemiology; Humans; Incidence; Kaplan-Meier Estimate; Male; Middle Aged; Patients; Postoperative Complications - chemically induced; Postoperative Complications - epidemiology; Stroke; Stroke - prevention & control; Thromboembolism; Vitamin K; Warfarin; Warfarin - administration & dosage; Warfarin - adverse effects
• ISSN: 0028-4793; 1533-4406
• DOI: 10.1056/NEJMoa1701005

This open-label, randomized trial assessed the safety of uninterrupted dabigatran versus warfarin in 635 patients undergoing ablation for atrial fibrillation. The incidence of major bleeding events was significantly lower with dabigatran than with warfarin (1.6% vs. 6.9%). Catheter ablation of atrial fibrillation is a well-established treatment for symptomatic atrial fibrillation. Guidelines have incorporated catheter ablation of symptomatic atrial fibrillation as a class 1 or 2 indication, depending on previous antiarrhythmic treatment and type of atrial fibrillation. 1 – 3 The most important complications associated with ablation of atrial fibrillation are periprocedural stroke or transient ischemic attack (TIA) and cardiac tamponade. 3 Systemic anticoagulation before, during, and after ablation is important in reducing the risk of periprocedural cerebrovascular events. 3 To minimize these risks, heparin should be administered during ablation to maintain an activated clotting time of more than 300 seconds. However, . . .