Uninterrupted dabigatran administration provides greater inhibition against intracardiac activation of hemostasis as compared to vitamin k antagonists during cryoballoon catheter ablation of atrial fibrillation

Zsuzsa Bagoly, Orsolya Hajas, Réka Urbancsek, Alexandra Kiss, Edit Fiak, Ferenc Sarkady, Noémi Klára Tóth, Rita Orbán-Kálmándi, Kitti Bernadett Kovács, László Nagy, Attila Nagy, János Kappelmayer, László Csiba, Zoltán Csanádi

Research output: Contribution to journalArticlepeer-review

Abstract

Background. Cerebral thromboembolism is a rare but feared complication of transcatheter ablation in patients with atrial fibrillation (AF). Here, we aimed to test which pre-procedural anticoagulation strategy results in less intracardiac activation of hemostasis during ablation. Patients and methods. In this observational study, 54 paroxysmal/persistent AF patients undergoing cryoballoon ablation were grouped according to their periprocedural anticoagulation strategy: no anticoagulation (oral anticoagulation (OAC) free; n = 24), uninterrupted vitamin K antagonists (VKA) (n = 11), uninterrupted dabigatran (n = 17). Blood was drawn from the left atrium before and immediately after the ablation procedure. Cryoablations were performed according to standard protocols, during which heparin was administered. Heparin-insensitive markers of hemostasis and endothelial damage were tested from intracardiac samples: D-dimer, quantitative fibrin monomer (FM), plasmin-antiplasmin complex (PAP), von Willebrand factor (VWF) antigen, chromogenic factor VIII (FVIII) activity. Results. D-dimer increased significantly in all groups post-ablation, with lowest levels in the dabigatran group (median [interquartile range]: 0.27 [0.36] vs. 1.09 [1.30] and 0.74 [0.26] mg/L in OAC free and uninterrupted VKA groups, respectively, p < 0.001). PAP levels were parallel to this observation. Post-ablation FM levels were elevated in OAC free (26.34 [30.04] mg/L) and VKA groups (10.12 [16.01] mg/L), but remained below cut-off in all patients on dabigatran (3.98 [2.0] mg/L; p < 0.001). VWF antigen and FVIII activity increased similarly post-ablation in all groups, suggesting comparable procedure-related endothelial damage. Conclusion. Dabigatran provides greater inhibition against intracardiac activation of hemostasis as compared to VKAs during cryoballoon catheter ablation.

Original languageEnglish (US)
Article number3050
Pages (from-to)1-13
Number of pages13
JournalJournal of Clinical Medicine
Volume9
Issue number9
DOIs
StatePublished - Sep 2020
Externally publishedYes

Keywords

  • Atrial fibrillation
  • Cryoballoon ablation
  • Dabigatran
  • Vitamin K antagonists

ASJC Scopus subject areas

  • Medicine(all)

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