Comparison of effectiveness and safety between uninterrupted direct oral anticoagulants with and without switching to dabigatran in atrial fibrillation ablation

Introduction: Recent studies have demonstrated the feasibility of uninterrupted direct oral anticoagulants (DOACs) with a temporary switch to dabigatran ("dabigatran bridge") for atrial fibrillation (AF) ablation. We compared the effectiveness and safety between uninterrupted DOACs with and without the "dabigatran bridge" in patients taking factor Xa inhibitors.

Methods: AF patients on factor Xa inhibitors (rivaroxaban/apixaban/edoxaban) undergoing catheter ablation were eligible (n = 348). Brain MRI was performed within 2 days after the procedure to detect silent cerebral events (SCEs). Rivaroxaban/apixaban/edoxaban were uninterruptedly used in 153 patients (Group 1); these DOACs were switched to dabigatran on the day of AF ablation in 195 patients (Group 2). After propensity score matching, the unfractionated heparin (UFH) amount and the activated clotting time (ACT) kinetics during the procedure, the SCE incidence, and the follow-up complications (30 days, thromboembolism and major/minor bleeding) in the two groups were compared.

Results: Group 2 had higher initial ACT value and shorter time to optimal ACT (>300 seconds) than Group 1 (184 ± 36 s vs 145 ± 22 s, and 34 ± 29 s vs 43 ± 34 s, P < .05, respectively). Group 2 tended to require less amount of UFH to achieve optimal ACT than Group 1, but the total amount of UFH for the procedure was comparable. Group 2 had lower SCE incidence than Group 1 (16.2% vs 26.4%, P < .05). The prevalence of follow-up complications was unchanged between the two groups.

Conclusions: Switching to dabigatran on the day of AF ablation decreases preclinical thromboembolic events with similar bleeding risk to uninterrupted factor Xa inhibitors.