PMID- 32528566
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20240328
IS  - 1880-4276 (Print)
IS  - 1883-2148 (Electronic)
IS  - 1880-4276 (Linking)
VI  - 36
IP  - 3
DP  - 2020 Jun
TI  - Comparison of effectiveness and safety between uninterrupted direct oral 
      anticoagulants with and without switching to dabigatran in atrial fibrillation 
      ablation.
PG  - 417-424
LID - 10.1002/joa3.12333 [doi]
AB  - 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.
CI  - (c) 2020 The Authors. Journal of Arrhythmia published by John Wiley & Sons 
      Australia, Ltd on behalf of the Japanese Heart Rhythm Society.
FAU - Harada, Masahide
AU  - Harada M
AUID- ORCID: 0000-0002-2345-9557
AD  - Department of Cardiology Fujita Health University Toyoake Japan.
FAU - Motoike, Yuji
AU  - Motoike Y
AD  - Department of Cardiology Fujita Health University Toyoake Japan.
FAU - Nomura, Yoshihiro
AU  - Nomura Y
AD  - Department of Cardiology Fujita Health University Toyoake Japan.
FAU - Nishimura, Asuka
AU  - Nishimura A
AD  - Department of Cardiology Fujita Health University Toyoake Japan.
FAU - Koshikawa, Masayuki
AU  - Koshikawa M
AD  - Department of Cardiology Fujita Health University Toyoake Japan.
FAU - Murayama, Kazuhiro
AU  - Murayama K
AD  - Joint Research Laboratory of Advanced Medical Imaging Fujita Health University 
      Toyoake Japan.
FAU - Ohno, Yoshiharu
AU  - Ohno Y
AD  - Joint Research Laboratory of Advanced Medical Imaging Fujita Health University 
      Toyoake Japan.
FAU - Watanabe, Eiichi
AU  - Watanabe E
AD  - Department of Cardiology Fujita Health University Toyoake Japan.
FAU - Izawa, Hideo
AU  - Izawa H
AD  - Department of Cardiology Fujita Health University Toyoake Japan.
FAU - Ozaki, Yukio
AU  - Ozaki Y
AD  - Department of Cardiology Fujita Health University Toyoake Japan.
LA  - eng
PT  - Journal Article
DEP - 20200318
PL  - Japan
TA  - J Arrhythm
JT  - Journal of arrhythmia
JID - 101263026
PMC - PMC7280006
OTO - NOTNLM
OT  - anticoagulant
OT  - atrial fibrillation
OT  - catheter ablation
OT  - silent brain infarction
OT  - thromboembolism
COIS- MH received speaker fees from Nippon Boehringer Ingelheim and Bristol-Myers 
      Squibb. EW received research funds from Daiichi-Sankyo and received speaker fee 
      from Bristol-Myers Squibb and Biotronik Japan. YM, YN, AN, MK, KM, YO, and YO 
      have nothing to disclose.
EDAT- 2020/06/13 06:00
MHDA- 2020/06/13 06:01
PMCR- 2020/03/18
CRDT- 2020/06/13 06:00
PHST- 2020/01/02 00:00 [received]
PHST- 2020/02/15 00:00 [revised]
PHST- 2020/03/01 00:00 [accepted]
PHST- 2020/06/13 06:00 [entrez]
PHST- 2020/06/13 06:00 [pubmed]
PHST- 2020/06/13 06:01 [medline]
PHST- 2020/03/18 00:00 [pmc-release]
AID - JOA312333 [pii]
AID - 10.1002/joa3.12333 [doi]
PST - epublish
SO  - J Arrhythm. 2020 Mar 18;36(3):417-424. doi: 10.1002/joa3.12333. eCollection 2020 
      Jun.