Uninterrupted NOAC superior to warfarin for ablation of AF in the RE-CIRCUIT study
Safety and Efficacy of Uninterrupted Anticoagulation With Dabigatran Etexilate Versus Warfarin in Patients Undergoing Catheter Ablation of Atrial Fibrillation: The RE-CIRCUIT Study
Presented at ACC.17 by Hough CalkinsNews - Mar. 19, 2017
- The percentage of patients with MBEs during ablation or in the first 8 weeks after the procedure was significantly lower in the dabigatran group compared with the warfarin group (1.6% vs. 6.9%; absolute risk difference: –5.3%; 95% CI: –8.4 to –2.2; P=0.0009). The RRR versus warfarin was 77.2%.
- Cox proportional-hazards analysis of the primary end point for dabigatran vs. warfarin revealed fewer MBEs from the time of ablation (HR: 0.22; 95% CI: 0.08 - 0.59).
- The incidence of minor bleeding events was similar in the two treatment groups (18.6% in the dabigatran group and 17.0% in the warfarin group).
- From the time of ablation until 8 weeks after ablation, there were no events of stroke, systemic embolism, or TIA in the dabigatran group and only one TIA event in the warfarin group.
- No fatal events were reported in either treatment group.
In AF patients undergoing ablation, periprocedural anticoagulation with uninterrupted dabigatran (150 mg twice daily) was associated with fewer bleeding complications compared with uninterrupted warfarin. The results of this study suggest that uninterrupted dabigatran administration is a better anticoagulation strategy for AF ablation as compared with warfarin. The availability of the specific reversal agent idarucizumab, while not needed in any patient in this trial, further motivates the adoption of uninterrupted dabigatran as the preferred anticoagulation strategy in patients undergoing AF ablation.
The commentator noted during the press conference that this study will most likely affect clinical practice, as it refutes some of the bleeding concerns. Now, a periprocedural strategy is available that is associated with minimal bleeding and reversal at hand.
Our coverage of ACC.17 is based on the information provided during the congress.