Periprocedural dabigatran use is associated with higher major bleeding rate than warfarin, study finds

Patients using periprocedural dabigatran had a significantly higher major bleeding rate than those using warfarin, according to a study published online first February 1, 2012, in the Journal of the American College of Cardiology.

Lead author Dhanunjaya Lakkireddy, MD, with the Cardiovascular Research Institute, Mid-America Cardiology at the University of Kansas Hospital and Medical Center in Kansas City, and fellow researchers set out to study the feasibility and safety of dabigatran during atrial fibrillation (AF) ablation, since the safety and efficacy of dabigatran as an anticoagulant for AF ablation are unknown.

The researchers performed a multicenter, observational study from a prospective registry, including all consecutive patients undergoing AF ablation in 8 high-volume centers in the United States. A total of 290 patients, including 145 taking periprocedural dabigatran and an equal number of matched patients taking uninterrupted periprocedural warfarin, were included in the study.

The dabigatran group had a significantly higher major bleeding rate of 6% versus 1% in the warfarin group, a total bleeding rate of 14% versus 6% in the warfarin group, and 16% composite of bleeding and thromboembolic complications versus 6% in the warfarin group.

“In patients undergoing AF ablation, continuation of dabigatran during the periprocedural period is associated with an increased risk of bleeding and composite of bleeding or embolic complications compared with uninterrupted warfarin therapy,” Lakkireddy wrote in the study. More studies are needed to identify the optimal periprocedural anticoagulation strategies in patients on dabigatran undergoing AF ablation, he added.