Uninterrupted Dabigatran Administration Provides Greater Inhibition against Intracardiac Activation of Hemostasis as Compared to Vitamin K Antagonists during Cryoballoon Catheter Ablation of Atrial Fibrillation
Abstract
:1. Introduction
2. Experimental Section
2.1. Study Population
2.2. Pre-Procedure Anticoagulation and Ablation Procedure
- No anticoagulation (OAC free group). All patients on no anticoagulation were considered low risk for thromboembolism (CHA2DS2-VASC-score 0–2).
- Uninterrupted vitamin K antagonist for at least 30 days pre-ablation to maintain a therapeutic international normalised ratio (INR) between 2–3, which was confirmed on the morning of the procedure (VKA group). In case the morning INR level was measured out of the therapeutic range, ablation was postponed and VKA dose adjusted as required.
- Dabigatran 150 mg BID for at least 30 days with the last dose given 2 h prior to the procedure (Dabigatran group). Dabigatran was administered to all patients exactly 2 h before the scheduled start of the ablation, by the form of controlled pill intake as inspected by a nurse.
2.3. Blood Sampling and Laboratory Investigations
2.4. Statistical Analysis
3. Results
3.1. Baseline Patient and Procedure Characteristics
3.2. Intracardiac Activation of Hemostasis and Fibrinolysis in AF Patients before and after the Ablation Procedure: Effect of Different Pre-Procedural Anticoagulation Strategies
3.3. Local Endothelial Activation in the Left Atrium of AF Patients before and after the Ablation Procedure
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Conflicts of Interest
References
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OAC Free (n = 24) | VKA (n = 11) | Dabigatran (n = 17) | p | |
---|---|---|---|---|
Age (years) | 51.2 ± 12.6 | 58.3 ± 10.8 | 56.3 ± 10.2 | 0.240 |
Male, n (%) | 15 (62.5) | 8 (72.7) | 11 (64.7) | 0.838 |
BMI (kg/m2) | 29.03 (26.68–31.49) | 29.02 (28.35–31.47) | 26.88 (24.89–30.93) | 0.558 |
Hypertension n (%) | 13 (54.2) | 7 (63.6) | 10 (58.89) | 0.489 |
Hypercholesterolemia n (%) | 13 (54.2) | 8 (72.7) | 7 (63.6) | 0.112 |
Smoking n (%) | 7 (29.2) | 2 (18.2) | 4 (23.5) | 0.479 |
Diabetes mellitus n (%) | 1 (4.2) | 2 (18.2) | 1 (5.9) | 0.386 |
Left atrium size (mm) | 40.54 ± 5.4 | 42.30 ± 3.30 | 41.3 ± 3.6 | 0.597 |
Left ventricular ejection fraction (%) | 57.38 ± 5.9 | 60.80 ± 8.04 | 55.93 ± 6.77 | 0.228 |
CHA2DS2-VASC, median (IQR) | 1 (0–2) | 1 (0–3) | 1 (0–2) | 0.780 |
INR before intervention | 0.96 ± 0.05 | 2.33 ± 0.32 | 1.18 ± 0.09 | <0.001 |
Dabigatran peak (ng/mL), median (range) | - | - | 165.6 (70.6–331.9) | - |
hsCRP (mg/L), median (IQR) | 1.4 (0.5–2.5) | 1.0 (0.5–2.5) | 1.7 (0.8–4.6) | 0.338 |
Duration of the procedure (min) | 70.08 ± 15.7 | 78.9 ± 33.7 | 65.5 ± 22.8 | 0.155 |
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Bagoly, Z.; Hajas, O.; Urbancsek, R.; Kiss, A.; Fiak, E.; Sarkady, F.; Tóth, N.K.; Orbán-Kálmándi, R.; Kovács, K.B.; Nagy, L.; et al. Uninterrupted Dabigatran Administration Provides Greater Inhibition against Intracardiac Activation of Hemostasis as Compared to Vitamin K Antagonists during Cryoballoon Catheter Ablation of Atrial Fibrillation. J. Clin. Med. 2020, 9, 3050. https://doi.org/10.3390/jcm9093050
Bagoly Z, Hajas O, Urbancsek R, Kiss A, Fiak E, Sarkady F, Tóth NK, Orbán-Kálmándi R, Kovács KB, Nagy L, et al. Uninterrupted Dabigatran Administration Provides Greater Inhibition against Intracardiac Activation of Hemostasis as Compared to Vitamin K Antagonists during Cryoballoon Catheter Ablation of Atrial Fibrillation. Journal of Clinical Medicine. 2020; 9(9):3050. https://doi.org/10.3390/jcm9093050
Chicago/Turabian StyleBagoly, Zsuzsa, Orsolya Hajas, Réka Urbancsek, Alexandra Kiss, Edit Fiak, Ferenc Sarkady, Noémi Klára Tóth, Rita Orbán-Kálmándi, Kitti Bernadett Kovács, László Nagy, and et al. 2020. "Uninterrupted Dabigatran Administration Provides Greater Inhibition against Intracardiac Activation of Hemostasis as Compared to Vitamin K Antagonists during Cryoballoon Catheter Ablation of Atrial Fibrillation" Journal of Clinical Medicine 9, no. 9: 3050. https://doi.org/10.3390/jcm9093050