Clinical Electrophysiology -> Atrial Fibrillation & Atrial Flutter: -> Pharmacology (Antiarrhythmic drugs and anticoagulants) D-PO02 - Poster Session II (ID 47) Poster

D-PO02-229 - The Clinical Importance Of Excessive Anticoagulant Effects Of Dabigatran For The Patients Undergoing Af Ablation (ID 266)

 J. Doi: Nothing relevant to disclose.


Background: The 2018 JCS/JHRS Guideline recommends that the catheter ablation for atrial fibrillation (AF) should be performed under uninterrupted oral anticoagulation with warfarin or dabigatran. Generally, it is not necessary to adjust the dosage delicately for dabigatran. However, the excessive prolongations of coagulation test are occasionally experienced.
Objective: The aim of this study is to elucidate the distinctive feature of excessive prolongations of coagulation test by administering dabigatran.
Methods: This study included consecutive 559 patients who underwent AF ablation under anticoagulation with dabigatran. According to an activated clotting time (ACT) measured just before heparin administration in ablation procedure, we divided the patients into 2 groups: Group-A (ACT>220 sec) and Group-B (ACT<219).
Results: In overall 559 patients, baseline PT-INR and ACT were 1.24±0.2 and 178.4±35.2 sec. A total of 50 patients including 24 patients taking low dose dabigatran (220mg/day) showed excessive prolongation of ACT, therefore they were classified into Group-A (8.9%). Univariate analysis revealed that there was a significant difference between group A and group B in age (p<0.01), gender (p<0.01), body height (p<0.01), body weight (p=0.03) and BNP levels (p=0.03). In multivariate analysis, the independent predictor of excessive prolongation of ACT was age (>70 years old, OR: 3.9; 95% CI: 1.9 to 8.2) and female gender (OR: 4.2; 95% CI: 1.5 to 11.8). Although the difference was not statistically significant, cardiac tamponade (4.0% vs. 1.7%) and hematoma at the puncture site (4.0% vs. 1.4%) were more frequently observed in Group-A.
Conclusion: Even in the patients taking reduced dabigatran, excessive anticoagulant effects were occasionally observed. It is important to understand the risk factor and to perform careful ablation for such patients.