Appropriate intraprocedural initial heparin dosing in patients undergoing catheter ablation for atrial fibrillation receiving uninterrupted non-vitamin-K antagonist oral anticoagulant treatment

• Published in: BMC cardiovascular disorders Vol. 21; no. 1; p. 214
• Main Authors: Zhang, Rong-Feng, Ma, Cheng-Ming, Wang, Na, Yang, Ming-Hui, Li, Wen-Wen, Yin, Xiao-Meng, Dong, Ying-Xue, Yu, Xiao-Hong, Xiao, Xian-Jie, Xia, Yun-Long, Gao, Lian-Jun
• Format: Journal Article
• Language: English
• Published: England BioMed Central 27.04.2021; BMC
• Subjects: Ablation; Administration, Oral; Aged; Anticoagulants; Anticoagulants - administration & dosage; Anticoagulants - adverse effects; Atrial fibrillation; Atrial Fibrillation - complications; Atrial Fibrillation - diagnosis; Atrial Fibrillation - surgery; Bleeding; Blood transfusions; Cardiac arrhythmia; Catheter Ablation - adverse effects; Catheters; China; Clinical trials; Clotting; Dabigatran - administration & dosage; Dabigatran - adverse effects; Dosage; Double-Blind Method; Drug Administration Schedule; Drug Monitoring; Embolisms; Female; Fibrillation; Heart surgery; Heparin; Heparin - administration & dosage; Heparin - adverse effects; Humans; Male; Middle Aged; New oral anticoagulants; Patients; Postoperative Hemorrhage - chemically induced; Prospective Studies; Radiofrequency ablation; Radiofrequency catheter ablation; Risk Assessment; Risk Factors; Rivaroxaban - administration & dosage; Rivaroxaban - adverse effects; Stroke; Stroke - diagnosis; Stroke - etiology; Stroke - prevention & control; Thromboembolism; Thromboembolism - diagnosis; Thromboembolism - etiology; Thromboembolism - prevention & control; Time Factors; Treatment Outcome; Veins & arteries; Warfarin; Warfarin - administration & dosage; Warfarin - adverse effects; Whole Blood Coagulation Time; China; United States > US; Radiofrequency catheter ablation; Atrial fibrillation; New oral anticoagulants; Bleeding
• ISSN: 1471-2261; 1471-2261
• DOI: 10.1186/s12872-021-02032-3

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 ).