Anticoagulation treatment using dabigatran in perioperative period of catheter ablation of nonvalvular atrial fibrillation

Abstract

Objective The aim of this study is to evaluate the efficacy and safety of a new oral anticogulant dabigatran in patients with nonvalvular atrial fibrillation (NVAF) undergoing catheter ablation (RF). Methods In this study, 116 patients undergoing catheter ablation of atrial fibrillation from August 2014 to January 2016 in Shenyang General Hospital of PLA were enrolled .The blood coagulation indexes were compared between patients who had already taken dabigatran for more than 7 days before admission and patients without taking any anticoagulant before admission.The 116 patients were divided into 2 different wards(2 groups) after admission.In one ward (n=52), dabigatran was stopped and bridged with low molecular weight heparin (LMWH bridging group) for 2 times (before procedure and 4~6 hours after ablation). In the other ward (n=64), dabigatran was used continually just before and after catheter ablation of atrial fibrillation(dabigatran continual group). The first activated clotting time (ACT) value during ablation procedure was compared in both groups.The bleeding and thromboembolic events were also evaluated and compared during perioperative period and follow-up. Results There were significant differents in actived partial thromboplastin time(APTT) and prothrombin time(PT)between patients who have taken dabigatran for more than 7 days and who didn't take any anticoagulant before admissiion to hospital(P=0.000, P=0.029). A negative relationship between the first ACT value measured during ablation procedure and the timing of taking dabigatran before ablation procedure was obtained in dabigatran continual group.There were no significant differences in the incidences of mild bleeding and hematoma between LMWH bridging group and dabigatran continual group during peri-operative period and follow-up (P>0.05). Conclusion Dabigatran can increase the value of APTT when it reaches a stable pharmacokinetics stage.And it is effective and safe in atrial fibrillation patients who underwent catheter ablation in peri-operative period.The first ACT value measured during the ablation procedure in dabigatran continual group has a negative relationship with the time taking the last dabigatran before catheter ablation. Key words: Dabigatran; Atrial fibrillation; Catheter ablation; Activated clotting time