Premium
Comparative Safety of Periablation Anticoagulation Strategies for Atrial Fibrillation: Data from a Large Multicenter Study
Author(s) -
ARSHAD AYSHA,
JOHNSON CHRISTOPHER K.,
MITTAL SUNEET,
BUCH ERIC,
HAMAM ISMAIL,
TRAN THANH,
SHAW RICHARD E.,
MUSAT DAN,
PREMINGER MARK,
SICHROVSKY TINA,
HERWEG BENGT,
SHIVKUMAR KALYANAM,
HUMMEL JOHN,
STEINBERG JONATHAN S.
Publication year - 2014
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/pace.12401
Subject(s) - medicine , warfarin , dabigatran , atrial fibrillation , odds ratio , confidence interval , stroke (engine) , retrospective cohort study , cardiology , anesthesia , surgery , mechanical engineering , engineering
Background There are a variety of periprocedural anticoagulation strategies for atrial fibrillation (AF) ablation, including the use of dabigatran. It is unclear which strategy is superior. Objective To compare the safety and efficacy of anticoagulation with uninterrupted warfarin, dabigatran, and warfarin with heparin bridging in patients undergoing ablation of AF at four experienced centers. Methods and Results In this retrospective analysis, 882 patients (mean age: 61 ± 11 years) underwent ablation of AF using uninterrupted warfarin (n = 276), dabigatran (n = 374), or warfarin with heparin bridging (n = 232) for periprocedural anticoagulation. The rate of total complications was 23/276 (8.3%) in the uninterrupted warfarin group, 30/374 (8.0%) in the dabigatran group, and 29/232 (12.5%) in the bridged group (P = 0.15). Major complications were more frequent in the uninterrupted warfarin group 12/276 (4.3%) compared with 3/374 (0.8%) in dabigatran and 6/232 (2.6%) in the bridged group (P = 0.01). The most common major complication was the need for transfusion or occurrence of major bleeding. Minor complications did not differ among the three groups. On multivariate analysis, female gender (odds ratio [OR] 1.93, confidence interval [CI] 1.16–3.19, P = 0.011), bridging heparin (OR 2.13, CI 1.100–3.941, P = 0.016), use of triple antithrombotic therapy (OR 1.77, CI 1.05–2.98, P = 0.033), and prior myocardial infarction (OR 2.40, CI 1.01–5.67, P = 0.046) independently predicted total complications. Conclusions When comparing the use of uninterrupted warfarin, dabigatran, and warfarin with heparin bridging in patients undergoing catheter ablation of AF, dabigatran was not associated with increased risk, major complications were more common in the uninterrupted warfarin group, and after adjustment, warfarin with bridging increased total complications.