Low dose dabigatran versus uninterrupted acenocoumarol for peri-procedural anticoagulation in atrial fibrillation catheter ablation

•This is the first study comparing the safety and efficacy of uninterrupted acenocoumarol therapy and low dose dabigatran regimen (110 mg twice a day) in patients undergoing catheter ablation of atrial fibrillation.•The low dose dabigatran regimen provides safe and effective peri-procedural anticoagulation in patients undergoing left atrial ablation compared with uninterrupted acenocoumarol therapy.•The average activated clotting time throughout the procedure is higher for the acenocoumarol group, despite the more aggressive anticoagulation with higher doses of heparin in the dabigatran group.

BackgroundLeft atrial ablation for atrial fibrillation (AF) is associated with a transiently increased risk of thromboembolic and hemorrhagic events. We tested the hypothesis that the low dose dabigatran [110 mg twice a day (bid)] can be safely used as an alternative to uninterrupted acenocoumarol for periprocedural anticoagulation in left atrial ablation procedures.Methods and ResultsA total of 149 consecutive patients undergoing pulmonary vein antral isolation for AF were included; 64 patients were on low dose dabigatran (110 mg bid) and 85 patients were on acenocoumarol with therapeutic international normalized ratios. Two doses of dabigatran were withheld before the procedure and the drug was restarted 4 hours after vascular hemostasis. Overall, the two groups were well-matched. Hemorrhagic and thromboembolic complications were similar in both groups within 90 days from the procedure (4.7% for the dabigatran group versus 9.4% for the acenocoumarol group; P = 0.275). Major hemorrhage occurred in 1.6% in the dabigatran group versus 3.5% in the acenocoumarol group (P = 0.462). A single thromboembolic event occurred in the dabigatran group (1.6%) versus 2 (2.4%) in the acenocoumarol group (P = 0.734). Despite higher doses of intraprocedural heparin (P < 0.01), the mean activated clotting time was significantly lower in patients who were on dabigatran than those on acenocoumarol (P < 0.01).ConclusionsThe low dose dabigatran regimen provides safe and effective peri-procedural anticoagulation in patients undergoing left atrial ablation for AF compared with uninterrupted acenocoumarol therapy.