RESUMO
BACKGROUND AND OBJECTIVES: Two new oral anticoagulants, rivaroxaban and dabigatran, with no need for anticoagulation monitoring, are available for patients with atrial fibrillation (AF). We aimed to compare their anticoagulant effects and safety when used during the AF ablation periprocedural period. METHODS: Patients undergoing AF ablation were randomly assigned to receive rivaroxaban 15 mg once daily (N = 30) or dabigatran 110 mg twice daily (N = 30). Rivaroxaban was withheld on the morning of the day before the ablation, and dabigatran was discontinued from the evening of the day before the procedure. Both anticoagulants were then resumed after haemostasis of the access site. D-dimer levels were measured just before the ablation, at the end of the ablation, and at 24 h and 48 h after the procedure. RESULTS: The baseline D-dimer levels were identical in both groups. However, D-dimer levels increased more markedly following the ablation procedure in patients receiving rivaroxaban than in those receiving dabigatran (mean ± standard deviation from 0.62 ± 0.16 to 1.09 ± 0.38 µg/mL vs from 0.59 ± 0.08 to 0.75 ± 0.17 µg/mL; p < 0.0001). The rate of rebleeding from the access site was similar in patients receiving rivaroxaban and those receiving dabigatran (33 vs 27%; p = 0.78). CONCLUSION: As compared with dabigatran, rivaroxaban may increase the risk of hypercoagulability when used during the periprocedural period of AF ablation, suggesting a potential rebound effect of rivaroxaban or a mismatch between its half-life and dose regimen.