Anticoagulation Treatment Using Dabigatran During Perioperative Period Of Catheter Ablation Of Nonvalvular Atrial Fibrillation: The Effects Of Low Molecular Weight Heparin Bridging And Not Bridging On ACT Value And Clinical Events

Objective 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,the anticoagulation efficacy and safety of dabigatran was evaluated in 100 patients with nonvalvular atrial fibrillation who underwent catheter ablation between August 2014 to March 2015.The blood coagulation indexes were compared between 30 patients who have already taken dabigatran for more than 7 days before admission and 27 patients without taking any anticoagulant before admission.Transesophageal echocardiogram was used before ablation to exclude left atrial appendage thrombus.The 100 patients were divided into 2 groups.In Group1(51 cases),dabigatran was stopped and bridged with low molecular weight heparin(LMWH)for 2 times(before procedure and 5 hours after ablation).In Group 2(49 cases),dabigatran was used continulllywithout bridging of LMWH just before and after catheter ablation of atrial fibrillation.The influencing factors on the value of ACT,including body weight,body mass index(BMI),creatinine clearance,creatinine,heparin dosage,were analyzed in two groups.The bleeding and thromboembolic events,and other complications were also observed during peri-operative period and 3-month follow-up.Results No significant differences were observed between two groups in baseline data,including age,height,body weight,length of hospital stay and creatinine(P >0.05).For blood coagulation indexes,there were significant differences in APTT and PT between patients having taken dabigatran for more than 7 days and not taking any anticogulant before admission to hosoital(P<0.05),but there was not difference in INR between these two groups(P>0.05)..There were not significant differences in the incidences of mild bleeding and hematoma betweent LMWH bridging group and dabigatran continual group during peri-operative period and at 3 month follow up(P>0.05).One patient experienced deep venous thrombosis in dabigatran continual group.In dabigatran continual group,multi-factor regression equation showed: ACT=451.44-12.90 H +2.27G;in LMWH bridging group,ACT=222.49-6.96H-0.02G+1.77A。Conclusion Dabigatran could increase the value of APTT when dabigaran reached stable pharmacokinetics.The first ACT value measured during the ablation procedure in dabigatran continual group patients was in relation to the time taking the last dabigatran before catheter ablation,,the unfractionated heparin dosage and body weight.The first ACT value in LMWH bridging group was associated with body weight and body mass index.In atrial fibrillation patients undergoing catheter ablation,dabigatran is effective and safe.