Appropriate intraprocedural initial heparin dosing in patients undergoing catheter ablation for atrial fibrillation receiving uninterrupted non-vitamin-K antagonist oral anticoagulant treatment.
Administration, Oral
Aged
Anticoagulants
/ administration & dosage
Atrial Fibrillation
/ complications
Catheter Ablation
/ adverse effects
China
Dabigatran
/ administration & dosage
Double-Blind Method
Drug Administration Schedule
Drug Monitoring
Female
Heparin
/ administration & dosage
Humans
Male
Middle Aged
Postoperative Hemorrhage
/ chemically induced
Prospective Studies
Risk Assessment
Risk Factors
Rivaroxaban
/ administration & dosage
Stroke
/ diagnosis
Thromboembolism
/ diagnosis
Time Factors
Treatment Outcome
Warfarin
/ administration & dosage
Whole Blood Coagulation Time
Atrial fibrillation
Bleeding
New oral anticoagulants
Radiofrequency catheter ablation
Journal
BMC cardiovascular disorders
ISSN: 1471-2261
Titre abrégé: BMC Cardiovasc Disord
Pays: England
ID NLM: 100968539
Informations de publication
Date de publication:
27 04 2021
27 04 2021
Historique:
received:
21
02
2021
accepted:
21
04
2021
entrez:
28
4
2021
pubmed:
29
4
2021
medline:
22
12
2021
Statut:
epublish
Résumé
To clarify the appropriate initial dosage of heparin during radiofrequency catheter ablation (RFCA) in patients with atrial fibrillation (AF) receiving uninterrupted nonvitamin K antagonist oral anticoagulant (NOAC) treatment. A total of 187 consecutive AF patients who underwent their first RFCA in our center were included. In the warfarin group (WG), an initial heparin dose of 100 U/kg was administered (control group: n = 38). The patients who were on NOACs were randomly divided into 3 NOAC groups (NG: n = 149), NG110, NG120, and NG130, and were administered initial heparin doses of 110 U/kg, 120 U/kg, and 130 U/kg, respectively. During RFCA, the activated clotting time (ACT) was measured every 15 min, and the target ACT was maintained at 250-350 s by intermittent heparin infusion. The baseline ACT and ACTs at each 15-min interval, the average percentage of measurements at the target ACT, and the incidence of periprocedural bleeding and thromboembolic complications were recorded and analyzed. There was no significant difference in sex, age, weight, or baseline ACT among the four groups. The 15 min-ACT, 30 min-ACT, and 45 min-ACT were significantly longer in the WG than in NG110 and NG120. However, no significant difference in 60 min-ACT or 75 min-ACT was detected. The average percentages of measurements at the target ACT in NG120 (82.2 ± 23.6%) and NG130 (84.8 ± 23.7%) were remarkably higher than those in the WG (63.4 ± 36.2%, p = 0.007, 0.003, respectively). These differences were independent of the type of NOAC. The proportion of ACTs in 300-350 s in NG130 was higher than in WG (32.4 ± 31.8 vs. 34.7 ± 30.6, p = 0.735). Severe periprocedural thromboembolic and bleeding complications were not observed. For patients with AF receiving uninterrupted NOAC treatment who underwent RFCA, an initial heparin dosage of 120 U/kg or 130 U/kg can provide an adequate intraprocedural anticoagulant effect, and 130 U/kg allowed ACT to reach the target earlier. Registration number: ChiCTR1800016491, First Registration Date: 04/06/2018 (Chinese Clinical Trial Registry http://www.chictr.org.cn/index.aspx ).
Sections du résumé
BACKGROUND
To clarify the appropriate initial dosage of heparin during radiofrequency catheter ablation (RFCA) in patients with atrial fibrillation (AF) receiving uninterrupted nonvitamin K antagonist oral anticoagulant (NOAC) treatment.
METHODS
A total of 187 consecutive AF patients who underwent their first RFCA in our center were included. In the warfarin group (WG), an initial heparin dose of 100 U/kg was administered (control group: n = 38). The patients who were on NOACs were randomly divided into 3 NOAC groups (NG: n = 149), NG110, NG120, and NG130, and were administered initial heparin doses of 110 U/kg, 120 U/kg, and 130 U/kg, respectively. During RFCA, the activated clotting time (ACT) was measured every 15 min, and the target ACT was maintained at 250-350 s by intermittent heparin infusion. The baseline ACT and ACTs at each 15-min interval, the average percentage of measurements at the target ACT, and the incidence of periprocedural bleeding and thromboembolic complications were recorded and analyzed.
RESULTS
There was no significant difference in sex, age, weight, or baseline ACT among the four groups. The 15 min-ACT, 30 min-ACT, and 45 min-ACT were significantly longer in the WG than in NG110 and NG120. However, no significant difference in 60 min-ACT or 75 min-ACT was detected. The average percentages of measurements at the target ACT in NG120 (82.2 ± 23.6%) and NG130 (84.8 ± 23.7%) were remarkably higher than those in the WG (63.4 ± 36.2%, p = 0.007, 0.003, respectively). These differences were independent of the type of NOAC. The proportion of ACTs in 300-350 s in NG130 was higher than in WG (32.4 ± 31.8 vs. 34.7 ± 30.6, p = 0.735). Severe periprocedural thromboembolic and bleeding complications were not observed.
CONCLUSIONS
For patients with AF receiving uninterrupted NOAC treatment who underwent RFCA, an initial heparin dosage of 120 U/kg or 130 U/kg can provide an adequate intraprocedural anticoagulant effect, and 130 U/kg allowed ACT to reach the target earlier.
TRIAL REGISTRATION
Registration number: ChiCTR1800016491, First Registration Date: 04/06/2018 (Chinese Clinical Trial Registry http://www.chictr.org.cn/index.aspx ).
Identifiants
pubmed: 33906609
doi: 10.1186/s12872-021-02032-3
pii: 10.1186/s12872-021-02032-3
pmc: PMC8077881
doi:
Substances chimiques
Anticoagulants
0
Warfarin
5Q7ZVV76EI
Heparin
9005-49-6
Rivaroxaban
9NDF7JZ4M3
Dabigatran
I0VM4M70GC
Types de publication
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
214Références
Circ Arrhythm Electrophysiol. 2012 Apr;5(2):302-11
pubmed: 22271713
Europace. 2018 Oct 1;20(10):1612-1620
pubmed: 29982383
J Cardiovasc Electrophysiol. 2016 Jun;27(6):683-93
pubmed: 27004444
Clin Drug Investig. 2016 Oct;36(10):837-48
pubmed: 27389243
Eur Heart J. 2019 Sep 21;40(36):3013-3021
pubmed: 30976787
Am J Cardiol. 2018 Feb 15;121(4):445-449
pubmed: 29289359
Stroke. 2015 Sep;46(9):2555-61
pubmed: 26304863
Heart Rhythm. 2014 Jun;11(6):963-8
pubmed: 24681115
Eur Heart J. 2015 Jul 21;36(28):1805-11
pubmed: 25975659
Eur Heart J. 2021 Feb 1;42(5):373-498
pubmed: 32860505
J Cardiovasc Electrophysiol. 2013 May;24(5):510-5
pubmed: 23350877
JACC Clin Electrophysiol. 2018 Jun;4(6):794-806
pubmed: 29929673
Circ Arrhythm Electrophysiol. 2013 Jun;6(3):460-6
pubmed: 23553523
Circulation. 2001 Jun 19;103(24):2994-3018
pubmed: 11413093
Circulation. 2019 Jul 9;140(2):e125-e151
pubmed: 30686041
Lancet. 2014 Mar 15;383(9921):955-62
pubmed: 24315724
BMJ. 2018 May 9;361:k1717
pubmed: 29743285
J Am Heart Assoc. 2018 Apr 5;7(8):
pubmed: 29622587
Heart Vessels. 2019 May;34(5):832-841
pubmed: 30390125
N Engl J Med. 2017 Apr 27;376(17):1627-1636
pubmed: 28317415
Heart Rhythm. 2017 Oct;14(10):e275-e444
pubmed: 28506916
J Am Board Fam Med. 2015 Jul-Aug;28(4):510-22
pubmed: 26152444
JACC Clin Electrophysiol. 2016 Jun;2(3):319-326
pubmed: 29766891
Circulation. 2014 Apr 22;129(16):1688-94
pubmed: 24753548
Pharmacotherapy. 2017 Sep;37(9):1150-1163
pubmed: 28672100
JACC Clin Electrophysiol. 2018 Dec;4(12):1598-1609
pubmed: 30573125
Sci Rep. 2019 May 22;9(1):7695
pubmed: 31118449
Pacing Clin Electrophysiol. 2015 Oct;38(10):1142-50
pubmed: 26014444
JAMA. 2019 Apr 2;321(13):1261-1274
pubmed: 30874766
J Am Coll Cardiol. 2014 Dec 2;64(21):e1-76
pubmed: 24685669
Ann Pharmacother. 2015 Mar;49(3):278-84
pubmed: 25515868