Continuous warfarin versus periprocedural dabigatran to reduce stroke and systemic embolism in patients undergoing catheter ablation for atrial fibrillation or left atrial flutter

被引:34
作者
Kaiser, Daniel W. [1 ]
Streur, Megan M. [1 ]
Nagarakanti, Rangadham [1 ]
Whalen, S. Patrick [1 ]
Ellis, Christopher R. [1 ]
机构
[1] Vanderbilt Univ, Med Ctr, Nashville, TN 37235 USA
关键词
Atrial fibrillation; Catheter ablation; Anticoagulation; Dabigatran; Complications; DIRECT THROMBIN INHIBITOR; INTERNATIONAL NORMALIZED RATIO; RADIOFREQUENCY ABLATION; ANTICOAGULATION; ETEXILATE; MANAGEMENT; PHARMACODYNAMICS; PHARMACOKINETICS; COMPLICATIONS; SAFETY;
D O I
10.1007/s10840-013-9793-7
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Left atrial catheter ablation for patients with atrial fibrillation (AF) requires periprocedural anticoagulation to minimize thromboembolic complications. High rates of major bleeding complications using dabigatran etexilate for periprocedural anticoagulation have been reported, raising concerns regarding its safety during left atrial catheter ablation. We sought to evaluate the safety and efficacy of a dabigatran use strategy versus warfarin, at a single high-volume AF ablation center. We performed a retrospective analysis on consecutive patients undergoing left atrial ablation at Vanderbilt Medical Center from January 2011 through August 2012 with a minimum follow-up of 3 months. Patient cohorts were divided into two groups, those utilizing dabigatran etexilate pre- and post-ablation and those undergoing ablation on dose-adjusted warfarin, with or without low-molecular-weight heparin bridging. Dabigatran was held 24-30 h pre-procedure and restarted 4-6 h after hemostasis was achieved. We evaluated all thromboembolic and bleeding complications at 3 months post-ablation. A total of 254 patients underwent left atrial catheter ablation for atrial fibrillation or left atrial flutter. Periprocedural anticoagulation utilized dabigatran in 122 patients and warfarin in 135 patients. Three late thromboembolic complications occurred in the dabigatran group (2.5 %), compared with one (0.7 %) in the warfarin group (p = 0.28). The dabigatran group had similar minor bleeding (2.5 vs. 7.4 %, p = 0.07), major bleeding (1.6 vs. 0.7 %, p = 0.51), and composite of bleeding and thromboembolic complications (6.6 vs. 8.9 %, p = 0.49) when compared to warfarin. There were no acute thromboembolic complications in either group (< 24 h post-ablation). In patients undergoing left atrial catheter ablation for AF or left atrial flutter, use of periprocedural dabigatran etexilate provides a safe and effective anticoagulation strategy compared to warfarin. A prospective randomized study is warranted.
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页码:241 / 247
页数:7
相关论文
共 26 条
[1]   Effectiveness of a strategy to reduce major vascular complications from catheter ablation of atrial fibrillation [J].
Abhishek, Fnu ;
Heist, Edwin Kevin ;
Barrett, Conor ;
Danik, Stephan ;
Blendea, Dan ;
Correnti, Christina ;
Khan, Zaka ;
Ruskin, Jeremy N. ;
Mansour, Moussa .
JOURNAL OF INTERVENTIONAL CARDIAC ELECTROPHYSIOLOGY, 2011, 30 (03) :211-215
[2]   2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design [J].
Calkins, Hugh ;
Kuck, Karl Heinz ;
Cappato, Riccardo ;
Brugada, Josep ;
Camm, A. John ;
Chen, Shih-Ann ;
Crijns, Harry J. G. ;
Damiano, Ralph J., Jr. ;
Davies, D. Wyn ;
DiMarco, John ;
Edgerton, James ;
Ellenbogen, Kenneth ;
Ezekowitz, Michael D. ;
Haines, David E. ;
Haissaguerre, Michel ;
Hindricks, Gerhard ;
Iesaka, Yoshito ;
Jackman, Warren ;
Jalife, Jose ;
Jais, Pierre ;
Kalman, Jonathan ;
Keane, David ;
Kim, Young-Hoon ;
Kirchhof, Paulus ;
Klein, George ;
Kottkamp, Hans ;
Kumagai, Koichiro ;
Lindsay, Bruce D. ;
Mansour, Moussa ;
Marchlinski, Francis E. ;
McCarthy, Patrick M. ;
Mont, J. Lluis ;
Morady, Fred ;
Nademanee, Koonlawee ;
Nakagawa, Hiroshi ;
Natale, Andrea ;
Nattel, Stanley ;
Packer, Douglas L. ;
Pappone, Carlo ;
Prystowsky, Eric ;
Raviele, Antonio ;
Reddy, Vivek ;
Ruskin, Jeremy N. ;
Shemin, Richard J. ;
Tsao, Hsuan-Ming ;
Wilber, David ;
Ad, Niv ;
Cummings, Jennifer ;
Gillinov, A. Mark ;
Heidbuchel, Hein .
EUROPACE, 2012, 14 (04) :528-606
[3]   Updated Worldwide Survey on the Methods, Efficacy, and Safety of Catheter Ablation for Human Atrial Fibrillation [J].
Cappato, Riccardo ;
Calkins, Hugh ;
Chen, Shih-Ann ;
Davies, Wyn ;
Iesaka, Yoshito ;
Kalman, Jonathan ;
Kim, You-Ho ;
Klein, George ;
Natale, Andrea ;
Packer, Douglas ;
Skanes, Allan ;
Ambrogi, Federico ;
Biganzoli, Elia .
CIRCULATION-ARRHYTHMIA AND ELECTROPHYSIOLOGY, 2010, 3 (01) :32-38
[4]   Dabigatran versus Warfarin in Patients with Atrial Fibrillation. [J].
Connolly, Stuart J. ;
Ezekowitz, Michael D. ;
Yusuf, Salim ;
Eikelboom, John ;
Oldgren, Jonas ;
Parekh, Amit ;
Pogue, Janice ;
Reilly, Paul A. ;
Themeles, Ellison ;
Varrone, Jeanne ;
Wang, Susan ;
Alings, Marco ;
Xavier, Denis ;
Zhu, Jun ;
Diaz, Rafael ;
Lewis, Basil S. ;
Darius, Harald ;
Diener, Hans-Christoph ;
Joyner, Campbell D. ;
Wallentin, Lars .
NEW ENGLAND JOURNAL OF MEDICINE, 2009, 361 (12) :1139-1151
[5]   Periprocedural Stroke and Management of Major Bleeding Complications in Patients Undergoing Catheter Ablation of Atrial Fibrillation [J].
Di Biase, Luigi ;
Burkhardt, J. David ;
Mohanty, Prasant ;
Sanchez, Javier ;
Horton, Rodney ;
Gallinghouse, G. Joseph ;
Lakkireddy, Dhanunjay ;
Verma, Atul ;
Khaykin, Yaariv ;
Hongo, Richard ;
Hao, Steven ;
Beheiry, Salwa ;
Pelargonio, Gemma ;
Dello Russo, Antonio ;
Casella, Michela ;
Santarelli, Pietro ;
Santangeli, Pasquale ;
Wang, Paul ;
Al-Ahmad, Amin ;
Patel, Dimpi ;
Themistoclakis, Sakis ;
Bonso, Aldo ;
Rossillo, Antonio ;
Corrado, Andrea ;
Raviele, Antonio ;
Cummings, Jennifer E. ;
Schweikert, Robert A. ;
Lewis, William R. ;
Natale, Andrea .
CIRCULATION, 2010, 121 (23) :2550-2556
[6]   Atrial fibrillation ablation: Reaching the mainstream [J].
Fisher, JD ;
Spinelli, MA ;
Mookherjee, D ;
Krumerman, AK ;
Palma, EC .
PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY, 2006, 29 (05) :523-537
[7]   Radiofrequency Catheter Ablation of Atrial Fibrillation: A Cause of Silent Thromboembolism? Magnetic Resonance Imaging Assessment of Cerebral Thromboembolism in Patients Undergoing Ablation of Atrial Fibrillation [J].
Gaita, Fiorenzo ;
Caponi, Domenico ;
Pianelli, Martina ;
Scaglione, Marco ;
Toso, Elisabetta ;
Cesarani, Federico ;
Boffano, Carlo ;
Gandini, Giovanni ;
Valentini, Maria Consuelo ;
De Ponti, Roberto ;
Halimi, Franck ;
Leclercq, Jean Francois .
CIRCULATION, 2010, 122 (17) :1667-1673
[8]   Dabigatran Etexilate A Review of its Use in the Prevention of Stroke and Systemic Embolism in Patients with Atrial Fibrillation [J].
Garnock-Jones, Karly P. .
AMERICAN JOURNAL OF CARDIOVASCULAR DRUGS, 2011, 11 (01) :57-72
[9]   Catheter ablation of atrial fibrillation in patients with therapeutic oral anticoagulation treatment [J].
Hakalahti, Antti ;
Uusimaa, Paavo ;
Ylitalo, Kari ;
Raatikainen, M. J. Pekka .
EUROPACE, 2011, 13 (05) :640-645
[10]   Radiofrequency ablation of atrial fibrillation under therapeutic international normalized ratio: A safe and efficacious periprocedural anticoagulation strategy [J].
Hussein, Ayman A. ;
Martin, David O. ;
Saliba, Walid ;
Patel, Deven ;
Karim, Saima ;
Batal, Omar ;
Banna, Mustafa ;
Williams-Andrews, Michelle ;
Sherman, Minerva ;
Kanj, Mohamed ;
Bhargava, Mandeep ;
Dresing, Thomas ;
Callahan, Thomas ;
Tchou, Patrick ;
Di Biase, Luigi ;
Beheiry, Salwa ;
Lindsay, Bruce ;
Natale, Andrea ;
Wazni, Oussama .
HEART RHYTHM, 2009, 6 (10) :1425-1429