Anticoagulation with uninterrupted dabigatran was associated with fewer bleeding complications compared with uninterrupted warfarin among patients undergoing ablation for atrial fibrillation, according to a study published in the New England Journal of Medicine.
Hugh Calkins, MD, from Johns Hopkins Medical Institutions in Baltimore, and colleagues investigated the safety of uninterrupted dabigatran compared with warfarin in 635 patients undergoing paroxysmal or persistent ablation of atrial fibrillation across 104 sites.
The patients were randomly assigned to receive either dabigatran 150 mg twice daily or warfarin (target international normalized ratio 2.0 to 3.0). Patients underwent ablation after 4 to 8 weeks of uninterrupted anticoagulation, which was continued during and for 8 weeks after ablation. Researchers measured the incidence of major bleeding events during and up to 8 weeks after ablation as the primary end point. Secondary end points included thromboembolic and other bleeding events.
The rate of major bleeding events during ablation and up to 8 weeks afterward was lower with dabigatran compared with warfarin (1.6% vs 6.9%; absolute risk difference, -5.3 percentage points).
Dabigatran was also associated with fewer periprocedural pericardial tamponades and groin hematoma compared with warfarin. Both treatment groups had a similar rate of minor bleeding events, and 1 thromboembolic event occurred in the warfarin group.
“The mechanism of reducing major bleeding events with dabigatran may be related to the more specific mechanism of action (direct thrombin inhibition rather than a decrease in the production of several coagulation factors) and shorter half-life of dabigatran as compared with warfarin, as well as the presence of normal levels of factor VII and a stable anticoagulation effect,” the authors concluded.
- Calkins H, Willems S, Gerstenfeld EP, et al. Uninterrupted dabigatran versus warfarin for ablation in atrial fibrillation. N Engl J Med. 2017. doi:10.1056/NEJMoa1701005