Optimal time for dabigatran interruption before AF ablation likely between 8 and 24 hours

In atrial fibrillation (AF) patients undergoing catheter ablation (CA) using dabigatran as a preprocedural anticoagulant, an 8–24-hour interruption time of oral administration to ablation (O-A time) seems to be optimal, yielding no apparent bleeding complications, a recent study has found.

Integrating two prospective trials, the researchers assessed 535 patients, divided into three groups according to O-A times: <8 hours (n=258), 8–24 hours (n=191), and >24 hours (n=86). The primary endpoint was the incidence of major bleeding events during and up to 8 weeks after CA.

Eight patients developed major bleeding events over the course of the observation period. In patients with <8-hour O-A time, four such events were recorded on the day of CA, including two with pericardial tamponade/effusion and another two with vascular access bleeding. Another case of gastrointestinal bleeding was documented 36 days after CA.

The remaining three events occurred in patients with >24 hours of O-A time, including one case each of pericardial effusion, intraperitoneal bleeding, and vascular access bleeding. All of these three patients had two dabigatran doses interrupted prior to CA, and all bleeding episodes occurred on the day of or a day after CA.

No major bleeding events were reported in the 8–24-hour group (three-group comparison p=0.026).

“These data suggest that an O-A time of 8–24 h is optimal when considering the perspective of bleeding risk at the time of AF ablation,” the researchers said. “From a clinical perspective, we suggest that the interruption period be <24 h. In high thromboembolic-risk patients, no interruption may be optimal.”