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The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
Comparative safety of periablation anticoagulation strategies for atrial fibrillation: data from a large multicenter
Aysha Arshad1, Christopher K Johnson, Suneet Mittal
1Arrhythmia Institute, Valley Health System, New York, New York and Ridgewood, New Jersey.
Insights
Dabigatran is a safe and effective anticoagulation strategy for atrial fibrillation (AF) ablation. Uninterrupted warfarin was associated with more major complications, while warfarin with heparin bridging increased overall complications.
Area of Science:
- Cardiology
- Interventional Cardiology
- Pharmacology
Background:
- Atrial fibrillation (AF) ablation requires careful periprocedural anticoagulation.
- Current strategies include uninterrupted warfarin, dabigatran, and warfarin with heparin bridging.
- The optimal anticoagulation strategy remains unclear.
Purpose of the Study:
- To compare the safety and efficacy of three periprocedural anticoagulation strategies for AF ablation.
- Investigate complication rates associated with uninterrupted warfarin, dabigatran, and warfarin with heparin bridging.
Main Methods:
- Retrospective analysis of 882 patients undergoing AF ablation across four experienced centers.
- Patients received periprocedural anticoagulation with uninterrupted warfarin, dabigatran, or warfarin with heparin bridging.
- Complication rates (total, major, minor) were compared among the groups.
Main Results:
- Overall complication rates were similar across groups (warfarin: 8.3%, dabigatran: 8.0%, bridged: 12.5%).
- Major complications, primarily bleeding, were more frequent with uninterrupted warfarin (4.3%) compared to dabigatran (0.8%) and bridged warfarin (2.6%).
- Female gender, heparin bridging, triple antithrombotic therapy, and prior myocardial infarction independently predicted total complications.
Conclusions:
- Dabigatran demonstrated a favorable safety profile, not associated with increased risk in AF ablation.
- Uninterrupted warfarin was linked to a higher incidence of major complications.
- Warfarin with heparin bridging was associated with increased total complications after adjustment.
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.
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