Cardiovascular Disease: Cardiovascular Disease |

Impact of Renal Impairment on Activated Clotting Times in Patients Receiving Dabigatran or Rivaroxaban Prior to Atrial Ablation Procedures FREE TO VIEW

Jordan Ray, MD; David Snipelisky, MD; Harrison Goodall; Thomas Pascual; Christine Kauffman, RRT; Fred Kusumoto, MD
Author and Funding Information

Mayo Clinic, Jacksonville, FL

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):79A. doi:10.1016/j.chest.2016.08.087
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SESSION TITLE: Cardiovascular Disease

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM

PURPOSE: Dabigatran and rivaroxaban, commonly used novel anticoagulants, are used as alternatives to warfarin for stroke prevention in patients with atrial arrhythmias. Evidence suggests that the use of dabigatran in patients with renal impairment may increase exposure to active medication. The risk of bleeding complications in these patients particularly in atrial ablation procedures in unknown.

METHODS: We reviewed all patients undergoing atrial ablations over 3 years receiving either dabigatran or rivaroxaban prior to the ablation procedure. Patients with evidence of renal impairment (GFR<60mL/min) at the time of ablation procedure were compared to those with normal renal function. Basic clinical characteristics were obtained. Intraprocedural ACTs were recorded. Major bleeding complications were defined as need for transfusion or surgical intervention. Minor bleeding complications were defined as prolonged puncture site bleeding, hematoma formation or site bruising. Bleeding complications during the first two weeks following the ablation were evaluated.

RESULTS: A total of 181 patients met inclusion criteria, of which 124 and 57 patients were on dabigatran and rivaroxaban, respectively. Those with renal impairment taking dabigatran were older, with an average age of 69 years compared to 65 years without (p=0.03). No difference in other clinical characteristics was noted. The highest (p=0.012) and average (p=0.021) ACTs were higher in patients with renal impairment on dabigatran compared to those without. In patients with renal impairment, higher averaged ACT values were seen in the dabigatran cohort compared to the rivaroxaban cohort (p=0.004). No difference in bleeding complications at 48 hours and 2 weeks was noted among all cohorts.

CONCLUSIONS: An increase in intraprocedure ACT levels was found in patients with renal impairment on dabigatran but were not seen in patients on rivaroxaban. No major bleeding complications occured. We found no significant increased risk for minor bleeding complications in patients with renal impairment.

CLINICAL IMPLICATIONS: Providers should take this into account when performing ablation procedures on patients with renal impairment taking dabigatran.

DISCLOSURE: The following authors have nothing to disclose: Jordan Ray, David Snipelisky, Harrison Goodall, Thomas Pascual, Christine Kauffman, Fred Kusumoto

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