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Zeljkovic, I; Brusich, S; Scherr, D; Velagic, V; Traykov, V; Pernat, A; Anic, A; Szavits, Nossan, J; Jan, M; Bakotic, Z; Pezo, Nikolic, B; Radeljic, V; Bojko, A; Benko, I; Manola, S; Pavlovic, N.
Differences in activated clotting time and total unfractionated heparin dose during pulmonary vein isolation in patients on different anticoagulation therapy.
Clin Cardiol. 2021; 44(8):1177-1182 Doi: 10.1002/clc.23681 [OPEN ACCESS]
Web of Science PubMed PUBMED Central FullText FullText_MUG


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Scherr Daniel

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BACKGROUND: Periprocedural pulmonary vein isolation (PVI) anticoagulation requires balancing between bleeding and thromboembolic risk. Intraprocedural anticoagulation is monitored by activated clotting time (ACT) with target value >300 s, and there are no guidelines specifying an initial unfractionated heparin (UFH) dose. METHODS: We aimed to assess differences in ACT values and UFH dosage during PVI in patients on different oral anticoagulants. We conducted an international, multi-center, registry-based study. Consecutive patients with atrial fibrillation (AF) undergoing PVI, on uninterrupted anticoagulation therapy, were analyzed. Before transseptal puncture, UFH bolus of 100 IU/kg was administered regardless of the anticoagulation drug. RESULTS: Total of 873 patients were included (median age 61 years, IQR 53-66; female 30%). There were 248, 248, 189, 188 patients on warfarin, dabigatran, rivaroxaban, and apixaban, respectively. Mean initial ACT was 257 ± 50 s, mean overall ACT 295 ± 45 s and total UFH dose 158 ± 60 IU/kg. Patients who were receiving warfarin and dabigatran compared to patients receiving rivaroxaban and apixaban had: (i) significantly higher initial ACT values (262 ± 57 and 270 ± 48 vs. 248 ± 42 and 241 ± 44 s, p < .001), (ii) significantly higher ACT throughout PVI (309 ± 46 and 306 ± 44 vs. 282 ± 37 and 272 ± 42 s, p < .001), and (iii) needed lower UFH dose during PVI (140 ± 39 and 157 ± 71 vs. 171 ± 52 and 172 ± 70 IU/kg). CONCLUSION: There are significant differences in ACT values and UFH dose during PVI in patients receiving different anticoagulants. Patients on warfarin and dabigatran had higher initial and overall ACT values and needed lower UFH dose to achieve adequate anticoagulation during PVI than patients on rivaroxaban and apixaban.
Find related publications in this database (using NLM MeSH Indexing)
Aged - administration & dosage
Anticoagulants - adverse effects
Atrial Fibrillation - complications, diagnosis, drug therapy
Catheter Ablation - administration & dosage
Dabigatran - adverse effects
Female - administration & dosage
Heparin - adverse effects
Humans - administration & dosage
Middle Aged - administration & dosage
Pulmonary Veins - surgery
Pyridones - adverse effects
Rivaroxaban - adverse effects

Find related publications in this database (Keywords)
atrial fibrillation
pulmonary vein isolation
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