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J Arrhythm. 2017 December; 33(6): 655–656.
Published online 2017 September 20. doi:  10.1016/j.joa.2017.07.014
PMCID: PMC5728998

Uninterrupted dabigatran is safer than warfarin in patients undergoing ablation for atrial fibrillation

Michael Spartalis, MD, MSc, PhD,a,[low asterisk] Eleni Tzatzaki, MD, PhD,a Nikolaos I. Nikiteas, MD, MSc, PhD,b and Eleftherios Spartalis, MD, MSc, PhDb

Dear Editor

We read with great interest the article by Murakawa et al. [1] titled, “Report of periprocedural oral anticoagulants in catheter ablation for atrial fibrillation: The Japanese Catheter Ablation Registry of Atrial Fibrillation (J-CARAF).” The authors concluded that the choice of a novel oral anticoagulant (NOAC) as a periprocedural anticoagulant did not significantly alter the incidence of serious complications, compared with uninterrupted warfarin. However, is this true?

To answer this question, we performed a thorough search of the literature, which resulted in a significant number of recent studies regarding the periprocedural safety and efficacy of NOACs, especially dabigatran [2], [3], [4], [5]. Calkins et al., in a randomized, multicenter controlled trial of 704 patients, reported that in those undergoing ablation for atrial fibrillation (AF), anticoagulation with uninterrupted dabigatran was associated with fewer bleeding complications than uninterrupted warfarin [2]. The incidence of major bleeding episodes during and up to 8 weeks after ablation was lower with dabigatran than with warfarin [2].

A retrospective study from a prospective AF ablation registry presented similar results regarding dabigatran versus warfarin [3]. Dabigatran resulted in fewer minor bleeding episodes and total adverse events after AF ablation [3].

In addition, a comparative study of periprocedural anticoagulants concluded that more bleeding complications occurred with warfarin than with NOACs [4].

Finally, a recent meta-analysis that included 25 studies and a total of 11,686 patients with AF concurred that there is a lower risk of minor bleeding with NOACs than with warfarin [5].

Uninterrupted anticoagulation with a NOAC is associated with minimal bleeding and thromboembolic events [4]. Patients are increasingly being treated with NOACs. Therefore, the choice of NOAC as a periprocedural anticoagulant for AF ablation with minimum interruption of the patient's dosing schedule is a feasible alternative therapeutic strategy, which has been proven to be safe and effective.

Conflict of interest

All authors declare no conflict of interest related to this study.

References

1. Murakawa Y., Nogami A., Shoda M. Report of periprocedural oral anticoagulants in catheter ablation for atrial fibrillation: the Japanese Catheter Ablation Registry of Atrial Fibrillation (J-CARAF) J Arrhythm. 2017;33:172–176. [PubMed]
2. Calkins H., Willems S., Gerstenfeld E.P. Uninterrupted Dabigatran versus warfarin for ablation in atrial fibrillation. N Engl J Med. 2017;376:1627–1636. [PubMed]
3. Armbruster H.L., Lindsley J.P., Moranville M.P. Safety of novel oral anticoagulants compared with uninterrupted warfarin for catheter ablation of atrial fibrillation. Ann Pharmacother. 2015;49:278–284. [PubMed]
4. Okishige K., Nakamura T., Aoyagi H. Comparative study of hemorrhagic and ischemic complications among anticoagulants in patients undergoing cryoballoon ablation for atrial fibrillation. J Cardiol. 2017;69:11–15. [PubMed]
5. Wu S., Yang Y., Zhu J. Meta-analysis of efficacy and safety of new oral anticoagulants compared with uninterrupted vitamin K antagonists in patients undergoing catheter ablation for atrial fibrillation. Am J Cardiol. 2016;117:926–934. [PubMed]

Articles from Journal of Arrhythmia are provided here courtesy of Japanese Heart Rhythm Society