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Low bleeding and thromboembolic risk with continued dabigatran during cardiovascular interventions
The GLORIA-AF study
van der Wall, S. J., Lip, G. Y. H., Teutsch, C., Kalejs, O., Lyrer, P., Hall, C., Dubner, S. J., Diener, H.-C., Halperin, J. L., Ma, C. S., Rothman, K. J., Zint, K., Zhai, D., Huisman, M. V., & GLORIA-AF Investigators (2021). Low bleeding and thromboembolic risk with continued dabigatran during cardiovascular interventions: The GLORIA-AF study. European Journal of Internal Medicine, 91, 75-80. https://doi.org/10.1016/j.ejim.2021.05.020, https://doi.org/10.1016/j.ejim.2021.05.020
BACKGROUND: Prospective data on nonvitamin-K-antagonist oral anticoagulant (NOAC) management during cardiovascular interventions are limited. We therefore evaluated the safety and effectiveness of uninterrupted dabigatran therapy as well as dabigatran management during atrial fibrillation (AF)-cardioversions, AF-ablations, pacemaker implantations and coronary angiography and/or stenting procedures.
METHOD: GLORIA-AF is an international registry programme involving patients with newly diagnosed AF. Dabigatran users were followed for ≤2 years. The primary outcome was occurrence of stroke/systemic embolism and major bleeding ≤8 weeks after a cardiovascular intervention during uninterrupted dabigatran therapy.
RESULTS: During the 2-year follow-up, 599 cardiovascular interventions were identified in 479 eligible patients. 412/599 (69%) interventions were performed with uninterrupted dabigatran therapy: 299/354 (84%) AF-cardioversions, 38/89 (43%) AF-ablations, 25/58 (43%) pacemaker implantations, and 50/98 (51%) coronary angiography and/or stenting procedures. During an average follow-up of 8.4 weeks after intervention, one major bleed and one systemic embolic event occurred (risk 0.25% for both outcomes; 95% confidence interval, 0.01%-1.36%).
CONCLUSIONS: More than two thirds of the interventions were performed with uninterrupted dabigatran therapy, of which most were AF-cardioversions. Uninterrupted dabigatran therapy was associated with low major bleeding and stroke/systemic embolism risk, supporting the favourable safety and effectiveness profile of dabigatran in clinical practice-based settings.
