Post-procedural dabigatran versus interrupted warfarin therapy following catheter ablation for atrial fibrillation

Jeffrey Lin, Sharon Shen, Prashant Bhave, Bradley Knight, Martha Bohn, Evaldas Giedrimas, Taral K. Patel, Alexandru Chicos, Jeffrey Goldberger, Leonard Ilkhanoff, Susan Kim, Albert Lin, Rod Passman

Research output: Contribution to journalArticle

Abstract

Purpose:Patients undergoing catheter ablation for atrial fibrillation (AF) are at a higher risk of thromboembolic events post-procedure and therefore require therapeutic anticoagulation after ablation. Anticoagulation strategies include performing the procedure on or off therapeutic warfarin, though the latter approach requires post-procedure bridging therapy with low molecular-weight heparin (LMWH) until a therapeutic INR is achieved. The purpose of this study is to compare the safety and efficacy of post-ablation dabigatran as compared to warfarin with LMWH bridging. Methods: We performed a single-center retrospective analysis of consecutive patients who underwent catheter ablation for AF between January 2010 and December 2012 and received either post-procedure warfarin with a LMWH bridge or dabigatran. Warfarin was started the night of ablation; LMWH was started the next morning and continued until the INR was ≥ 2.0. Dabigatran was started the morning post-ablation. Results: The analysis included 324 patients. Of these, mean age was 60 ± 9 years, 78% were male, 81% had CHADS2 scores of 0 or 1, and 181 (56%) received dabigatran post-ablation. Patients who received dabigatran had lower CHADS2 scores and were more likely to be in NYHA Class I. At 30-days post-procedure, there were 0 thromboembolic or bleeding complications in the dabigatran group versus 4 (2.8%) in the warfarin group (p=0.037). There were no deaths in either group at 30 days post-ablation. Conclusions: Post-ablation dabigatran appears safe and efficacious compared to an interrupted warfarin strategy with LMWH bridging.

Original languageEnglish (US)
Pages (from-to)10-14
Number of pages5
JournalJournal of Atrial Fibrillation
Volume6
Issue number5
StatePublished - Jan 1 2014
Externally publishedYes

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Catheter Ablation
Warfarin
Atrial Fibrillation
Low Molecular Weight Heparin
International Normalized Ratio
Therapeutics
Dabigatran
Hemorrhage
Safety

Keywords

  • Anticoagulation
  • Dabigatran
  • Fibrillation ablation
  • Warfarin

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Lin, J., Shen, S., Bhave, P., Knight, B., Bohn, M., Giedrimas, E., ... Passman, R. (2014). Post-procedural dabigatran versus interrupted warfarin therapy following catheter ablation for atrial fibrillation. Journal of Atrial Fibrillation, 6(5), 10-14.

Post-procedural dabigatran versus interrupted warfarin therapy following catheter ablation for atrial fibrillation. / Lin, Jeffrey; Shen, Sharon; Bhave, Prashant; Knight, Bradley; Bohn, Martha; Giedrimas, Evaldas; Patel, Taral K.; Chicos, Alexandru; Goldberger, Jeffrey; Ilkhanoff, Leonard; Kim, Susan; Lin, Albert; Passman, Rod.

In: Journal of Atrial Fibrillation, Vol. 6, No. 5, 01.01.2014, p. 10-14.

Research output: Contribution to journalArticle

Lin, J, Shen, S, Bhave, P, Knight, B, Bohn, M, Giedrimas, E, Patel, TK, Chicos, A, Goldberger, J, Ilkhanoff, L, Kim, S, Lin, A & Passman, R 2014, 'Post-procedural dabigatran versus interrupted warfarin therapy following catheter ablation for atrial fibrillation', Journal of Atrial Fibrillation, vol. 6, no. 5, pp. 10-14.
Lin, Jeffrey ; Shen, Sharon ; Bhave, Prashant ; Knight, Bradley ; Bohn, Martha ; Giedrimas, Evaldas ; Patel, Taral K. ; Chicos, Alexandru ; Goldberger, Jeffrey ; Ilkhanoff, Leonard ; Kim, Susan ; Lin, Albert ; Passman, Rod. / Post-procedural dabigatran versus interrupted warfarin therapy following catheter ablation for atrial fibrillation. In: Journal of Atrial Fibrillation. 2014 ; Vol. 6, No. 5. pp. 10-14.
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abstract = "Purpose:Patients undergoing catheter ablation for atrial fibrillation (AF) are at a higher risk of thromboembolic events post-procedure and therefore require therapeutic anticoagulation after ablation. Anticoagulation strategies include performing the procedure on or off therapeutic warfarin, though the latter approach requires post-procedure bridging therapy with low molecular-weight heparin (LMWH) until a therapeutic INR is achieved. The purpose of this study is to compare the safety and efficacy of post-ablation dabigatran as compared to warfarin with LMWH bridging. Methods: We performed a single-center retrospective analysis of consecutive patients who underwent catheter ablation for AF between January 2010 and December 2012 and received either post-procedure warfarin with a LMWH bridge or dabigatran. Warfarin was started the night of ablation; LMWH was started the next morning and continued until the INR was ≥ 2.0. Dabigatran was started the morning post-ablation. Results: The analysis included 324 patients. Of these, mean age was 60 ± 9 years, 78{\%} were male, 81{\%} had CHADS2 scores of 0 or 1, and 181 (56{\%}) received dabigatran post-ablation. Patients who received dabigatran had lower CHADS2 scores and were more likely to be in NYHA Class I. At 30-days post-procedure, there were 0 thromboembolic or bleeding complications in the dabigatran group versus 4 (2.8{\%}) in the warfarin group (p=0.037). There were no deaths in either group at 30 days post-ablation. Conclusions: Post-ablation dabigatran appears safe and efficacious compared to an interrupted warfarin strategy with LMWH bridging.",
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AU - Lin, Jeffrey

AU - Shen, Sharon

AU - Bhave, Prashant

AU - Knight, Bradley

AU - Bohn, Martha

AU - Giedrimas, Evaldas

AU - Patel, Taral K.

AU - Chicos, Alexandru

AU - Goldberger, Jeffrey

AU - Ilkhanoff, Leonard

AU - Kim, Susan

AU - Lin, Albert

AU - Passman, Rod

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N2 - Purpose:Patients undergoing catheter ablation for atrial fibrillation (AF) are at a higher risk of thromboembolic events post-procedure and therefore require therapeutic anticoagulation after ablation. Anticoagulation strategies include performing the procedure on or off therapeutic warfarin, though the latter approach requires post-procedure bridging therapy with low molecular-weight heparin (LMWH) until a therapeutic INR is achieved. The purpose of this study is to compare the safety and efficacy of post-ablation dabigatran as compared to warfarin with LMWH bridging. Methods: We performed a single-center retrospective analysis of consecutive patients who underwent catheter ablation for AF between January 2010 and December 2012 and received either post-procedure warfarin with a LMWH bridge or dabigatran. Warfarin was started the night of ablation; LMWH was started the next morning and continued until the INR was ≥ 2.0. Dabigatran was started the morning post-ablation. Results: The analysis included 324 patients. Of these, mean age was 60 ± 9 years, 78% were male, 81% had CHADS2 scores of 0 or 1, and 181 (56%) received dabigatran post-ablation. Patients who received dabigatran had lower CHADS2 scores and were more likely to be in NYHA Class I. At 30-days post-procedure, there were 0 thromboembolic or bleeding complications in the dabigatran group versus 4 (2.8%) in the warfarin group (p=0.037). There were no deaths in either group at 30 days post-ablation. Conclusions: Post-ablation dabigatran appears safe and efficacious compared to an interrupted warfarin strategy with LMWH bridging.

AB - Purpose:Patients undergoing catheter ablation for atrial fibrillation (AF) are at a higher risk of thromboembolic events post-procedure and therefore require therapeutic anticoagulation after ablation. Anticoagulation strategies include performing the procedure on or off therapeutic warfarin, though the latter approach requires post-procedure bridging therapy with low molecular-weight heparin (LMWH) until a therapeutic INR is achieved. The purpose of this study is to compare the safety and efficacy of post-ablation dabigatran as compared to warfarin with LMWH bridging. Methods: We performed a single-center retrospective analysis of consecutive patients who underwent catheter ablation for AF between January 2010 and December 2012 and received either post-procedure warfarin with a LMWH bridge or dabigatran. Warfarin was started the night of ablation; LMWH was started the next morning and continued until the INR was ≥ 2.0. Dabigatran was started the morning post-ablation. Results: The analysis included 324 patients. Of these, mean age was 60 ± 9 years, 78% were male, 81% had CHADS2 scores of 0 or 1, and 181 (56%) received dabigatran post-ablation. Patients who received dabigatran had lower CHADS2 scores and were more likely to be in NYHA Class I. At 30-days post-procedure, there were 0 thromboembolic or bleeding complications in the dabigatran group versus 4 (2.8%) in the warfarin group (p=0.037). There were no deaths in either group at 30 days post-ablation. Conclusions: Post-ablation dabigatran appears safe and efficacious compared to an interrupted warfarin strategy with LMWH bridging.

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