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Uninterrupted Dabigatran Administration Provides Greater Inhibition against Intracardiac Activation of Hemostasis as Compared to Vitamin K Antagonists during Cryoballoon Catheter Ablation of Atrial Fibrillation

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...

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Autores principales: Bagoly, Zsuzsa, Hajas, Orsolya, Urbancsek, Réka, Kiss, Alexandra, Fiak, Edit, Sarkady, Ferenc, Tóth, Noémi Klára, Orbán-Kálmándi, Rita, Kovács, Kitti Bernadett, Nagy, László, Nagy, Attila, Kappelmayer, János, Csiba, László, Csanádi, Zoltán
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7563747/
https://www.ncbi.nlm.nih.gov/pubmed/32971765
http://dx.doi.org/10.3390/jcm9093050
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author Bagoly, Zsuzsa
Hajas, Orsolya
Urbancsek, Réka
Kiss, Alexandra
Fiak, Edit
Sarkady, Ferenc
Tóth, Noémi Klára
Orbán-Kálmándi, Rita
Kovács, Kitti Bernadett
Nagy, László
Nagy, Attila
Kappelmayer, János
Csiba, László
Csanádi, Zoltán
author_facet Bagoly, Zsuzsa
Hajas, Orsolya
Urbancsek, Réka
Kiss, Alexandra
Fiak, Edit
Sarkady, Ferenc
Tóth, Noémi Klára
Orbán-Kálmándi, Rita
Kovács, Kitti Bernadett
Nagy, László
Nagy, Attila
Kappelmayer, János
Csiba, László
Csanádi, Zoltán
author_sort Bagoly, Zsuzsa
collection PubMed
description 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.
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spelling pubmed-75637472020-10-27 Uninterrupted Dabigatran Administration Provides Greater Inhibition against Intracardiac Activation of Hemostasis as Compared to Vitamin K Antagonists during Cryoballoon Catheter Ablation of Atrial Fibrillation Bagoly, Zsuzsa Hajas, Orsolya Urbancsek, Réka Kiss, Alexandra Fiak, Edit Sarkady, Ferenc Tóth, Noémi Klára Orbán-Kálmándi, Rita Kovács, Kitti Bernadett Nagy, László Nagy, Attila Kappelmayer, János Csiba, László Csanádi, Zoltán J Clin Med Article 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. MDPI 2020-09-22 /pmc/articles/PMC7563747/ /pubmed/32971765 http://dx.doi.org/10.3390/jcm9093050 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Bagoly, Zsuzsa
Hajas, Orsolya
Urbancsek, Réka
Kiss, Alexandra
Fiak, Edit
Sarkady, Ferenc
Tóth, Noémi Klára
Orbán-Kálmándi, Rita
Kovács, Kitti Bernadett
Nagy, László
Nagy, Attila
Kappelmayer, János
Csiba, László
Csanádi, Zoltán
Uninterrupted Dabigatran Administration Provides Greater Inhibition against Intracardiac Activation of Hemostasis as Compared to Vitamin K Antagonists during Cryoballoon Catheter Ablation of Atrial Fibrillation
title Uninterrupted Dabigatran Administration Provides Greater Inhibition against Intracardiac Activation of Hemostasis as Compared to Vitamin K Antagonists during Cryoballoon Catheter Ablation of Atrial Fibrillation
title_full Uninterrupted Dabigatran Administration Provides Greater Inhibition against Intracardiac Activation of Hemostasis as Compared to Vitamin K Antagonists during Cryoballoon Catheter Ablation of Atrial Fibrillation
title_fullStr Uninterrupted Dabigatran Administration Provides Greater Inhibition against Intracardiac Activation of Hemostasis as Compared to Vitamin K Antagonists during Cryoballoon Catheter Ablation of Atrial Fibrillation
title_full_unstemmed Uninterrupted Dabigatran Administration Provides Greater Inhibition against Intracardiac Activation of Hemostasis as Compared to Vitamin K Antagonists during Cryoballoon Catheter Ablation of Atrial Fibrillation
title_short Uninterrupted Dabigatran Administration Provides Greater Inhibition against Intracardiac Activation of Hemostasis as Compared to Vitamin K Antagonists during Cryoballoon Catheter Ablation of Atrial Fibrillation
title_sort uninterrupted dabigatran administration provides greater inhibition against intracardiac activation of hemostasis as compared to vitamin k antagonists during cryoballoon catheter ablation of atrial fibrillation
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7563747/
https://www.ncbi.nlm.nih.gov/pubmed/32971765
http://dx.doi.org/10.3390/jcm9093050
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