Influence of the concomitant use of heparin on the effects of warfarin during catheter ablation for atrial fibrillation

• Published in: Heart and vessels Vol. 31; no. 3; pp. 397 - 401
• Main Authors: Inada, Keiichi, Matsuo, Seiichiro, Tokutake, Ken-ichi, Yokoyama, Ken-ichi, Hioki, Mika, Narui, Ryohsuke, Ito, Keiichi, Tanigawa, Shin-ichi, Yamashita, Seigo, Tokuda, Michifumi, Shibayama, Kenri, Miyanaga, Satoru, Sugimoto, Ken-ichi, Yoshimura, Michihiro, Yamane, Teiichi
• Format: Journal Article
• Language: English
• Published: Tokyo Springer Japan 01.03.2016; Springer Nature B.V
• Subjects: Adult; Aged; Anticoagulants - administration & dosage; Anticoagulants - adverse effects; Atrial Fibrillation - complications; Atrial Fibrillation - diagnosis; Atrial Fibrillation - therapy; Biomedical Engineering and Bioengineering; Blood clots; Blood Coagulation - drug effects; Blood Coagulation Tests; Blood Loss, Surgical - prevention & control; Cardiac arrhythmia; Cardiac Surgery; Cardiology; Catheter Ablation - adverse effects; Clinical outcomes; Drug Administration Schedule; Drug Monitoring - methods; Drug therapy; Female; Heparin - administration & dosage; Heparin - adverse effects; Heparin Antagonists - administration & dosage; Humans; Intubation; Male; Medicine; Medicine & Public Health; Middle Aged; Original Article; Postoperative Hemorrhage - chemically induced; Postoperative Hemorrhage - prevention & control; Predictive Value of Tests; Protamines - administration & dosage; Risk Factors; Thromboembolism - etiology; Thromboembolism - prevention & control; Time Factors; Treatment Outcome; Vascular Surgery; Warfarin - administration & dosage; Warfarin - adverse effects; Warfarin; Anticoagulation; Protamine; Atrial fibrillation; Catheter ablation
• ISSN: 0910-8327; 1615-2573
• DOI: 10.1007/s00380-014-0608-2

Warfarin is widely used to perform catheter ablation for atrial fibrillation (AF). Heparin is usually administered during this procedure to prevent thromboembolic events, while protamine is used to reduce the incidence of bleeding complications. The purpose of this study was to investigate the influence of heparin and protamine administration on the effects of warfarin and its safety. The subjects included 226 AF patients (206 males, 54.9 ± 9.1 years, paroxysmal/persistent AF: 118/108) undergoing AF ablation with the discontinuation of warfarin administration over 2 days. Heparin was administered to achieve an activated clotting time (ACT) above 300 s during the procedure. Several parameters of the coagulation status, including the prothrombin time international normalized ratio (PT-INR) and ACT values, measured immediately before and after protamine infusion were compared. The mean value of PT-INR prior to ablation was 1.9 ± 0.6. At the end of the procedure, the mean ACT and PT-INR values were 348.0 ± 52.9 and 2.9 ± 0.7, respectively. Following the infusion of 30 mg of protamine, both the ACT and PT-INR values significantly decreased, to 159.6 ± 31.0 ( p  < 0.0001) and 1.6 ± 0.3 ( p  < 0.0001), respectively. No cases of symptomatic cerebral infarction were observed, although femoral hematomas developed in 17 (7.5 %) of the patients without further consequence. The concomitant use of heparin augments the effect of warfarin. Meanwhile, protamine administration immediately reverses both the ACT and PT-INR, indicating the applicability of protamine for AF ablation in patients under the mixed administration of heparin and warfarin.