To add to the slew of information regarding anticoagulants, a study published online Sept. 28 in the Journal of Cardiovascular Electrophysiology found that dabigatran (Pradaxa, Boehringer Ingelheim) may be safe and well tolerated in atrial fibrillation (AF) patients after ablation. Dabigatran also was safe in terms of bleeding complications and thromboembolic events, leaving the authors to conclude that the drug may be a good alternative to warfarin.
While many studies have reported that dabigatran may trump warfarin in terms of stroke and death risk, there has been some controversy surrounding the drug after the FDA decided to approve the higher 150 mg dose rather than the 110 mg dose due to bleeding complications.
In the current study, Roger A. Winkle, MD, a cardiac electrophysiologist at Sequoia Hospital in Redwood City, Calif., and colleagues evaluated 123 patients who were administered dabigatran post-AF ablation to better assess whether dabigatran would be an alternative to warfarin post-ablation procedure.
Patients enrolled in the study were administered a 0.5 mg/kg dose of enoxaparin at the end of the procedure, which was repeated 12 hours later and then discontinued. Dabigatran was administered 22 hours post-ablation procedure.
The study’s primary endpoints were thromboembolic events, bleeding complications and side effects over a 30-day period.
During the study, 56 patients received warfarin as the pre-ablation anticoagulant, 34 patients received dabigatran and 26 patients received aspirin; seven patients received no anticoagulation agent prior to ablation. The authors reported that there were no preprocedural or intraprocedural episodes of bleeding or thromboembolic events. Of the patients who received dabigatran, three patients received a 75 mg dose and the rest received a 150 mg dose.
No post-ablation strokes, transient ischemic attacks or system thromboemboli were reported. Only three patients discontinued dabigatran and switched to warfarin due to side effects.
“Dabigatran is safe and well tolerated after AF ablation. It did not cause bleeding complications and there were no thromboembolic events,” Winkle and colleagues reported. “Dabigatran appears to be an alternative to warfarin after AF ablation.”