Clinical comparative study regarding interrupted and uninterrupted dabigatran therapy during perioperative periods of cryoballoon ablation for paroxysmal atrial fibrillation.
Aged
Anticoagulants
/ administration & dosage
Atrial Fibrillation
/ therapy
Brain
/ diagnostic imaging
Catheter Ablation
/ adverse effects
Dabigatran
/ administration & dosage
Drug Administration Schedule
Female
Humans
Incidence
Intracranial Embolism
/ epidemiology
Magnetic Resonance Imaging
Male
Middle Aged
Perioperative Period
/ methods
Postoperative Hemorrhage
/ epidemiology
Prospective Studies
Treatment Outcome
Atrial fibrillation
Cerebral embolism
Cryoballoon ablation
Dabigatran
Journal
Journal of cardiology
ISSN: 1876-4738
Titre abrégé: J Cardiol
Pays: Netherlands
ID NLM: 8804703
Informations de publication
Date de publication:
Aug 2019
Aug 2019
Historique:
received:
19
11
2018
revised:
08
02
2019
accepted:
11
02
2019
pubmed:
29
4
2019
medline:
26
6
2020
entrez:
29
4
2019
Statut:
ppublish
Résumé
Catheter manipulation in the left-sided heart is known as a risk for cerebral embolisms (CEs). However, anticoagulation therapy is terminated before catheter ablation (CA) of atrial fibrillation (AF) concerning adverse bleeding events. Little is known whether uninterrupted direct oral anticoagulants (DOACs) during perioperative period of CA could render the ablation procedure safer and reduce the incidence of CEs compared to interrupted DOACs. The aim of this study was to investigate the safety and usefulness of uninterrupted dabigatran during the periprocedural period for CA of AF. We included 333 patients with paroxysmal AF undergoing cryoballoon CA (CBA). They were prospectively divided into 2 groups based on whether DOACs were interrupted on the day of the CA (Group A, n=228) or dabigatran was not interrupted throughout perioperative period (Group B, n=105) in a non-randomized fashion. When the Group B patients had taken other DOACs rather than dabigatran before assignment, we changed those DOACs to dabigatran. Brain magnetic resonance imaging (MRI) was undertaken on the following day of the CA. Serious bleeding event cases were excluded from the study. The baseline characteristics including the CHADs2 score did not exhibit any significant differences between the groups. The brain MRI revealed an acute CEs in 82 patients, and was significantly higher in Group A than B (29% vs. 13%, respectively, p<0.01). There were no significant differences regarding the bleeding events (7% vs. 4%, respectively, p=0.62). Uninterrupted dabigatran therapy during the CBA of paroxysmal AF could significantly reduce the incidence of CEs.
Sections du résumé
BACKGROUND
BACKGROUND
Catheter manipulation in the left-sided heart is known as a risk for cerebral embolisms (CEs). However, anticoagulation therapy is terminated before catheter ablation (CA) of atrial fibrillation (AF) concerning adverse bleeding events. Little is known whether uninterrupted direct oral anticoagulants (DOACs) during perioperative period of CA could render the ablation procedure safer and reduce the incidence of CEs compared to interrupted DOACs. The aim of this study was to investigate the safety and usefulness of uninterrupted dabigatran during the periprocedural period for CA of AF.
METHODS
METHODS
We included 333 patients with paroxysmal AF undergoing cryoballoon CA (CBA). They were prospectively divided into 2 groups based on whether DOACs were interrupted on the day of the CA (Group A, n=228) or dabigatran was not interrupted throughout perioperative period (Group B, n=105) in a non-randomized fashion. When the Group B patients had taken other DOACs rather than dabigatran before assignment, we changed those DOACs to dabigatran. Brain magnetic resonance imaging (MRI) was undertaken on the following day of the CA. Serious bleeding event cases were excluded from the study.
RESULTS
RESULTS
The baseline characteristics including the CHADs2 score did not exhibit any significant differences between the groups. The brain MRI revealed an acute CEs in 82 patients, and was significantly higher in Group A than B (29% vs. 13%, respectively, p<0.01). There were no significant differences regarding the bleeding events (7% vs. 4%, respectively, p=0.62).
CONCLUSION
CONCLUSIONS
Uninterrupted dabigatran therapy during the CBA of paroxysmal AF could significantly reduce the incidence of CEs.
Identifiants
pubmed: 31029455
pii: S0914-5087(19)30039-5
doi: 10.1016/j.jjcc.2019.02.003
pii:
doi:
Substances chimiques
Anticoagulants
0
Dabigatran
I0VM4M70GC
Types de publication
Clinical Trial
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
150-155Informations de copyright
Copyright © 2019 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.