Coagulation and heparin requirements during ablation in patients under oral anticoagulant drugs. Issue 4 (19th May 2020)

• Record Type: Journal Article
• Authors: Maury, Philippe; Belaid, Slimane; Ribes, Agnès; Voglimacci‐Stephanopoli, Quentin; Mondoly, Pierre; Blaye, Marie; Mandel, Franck; Monteil, Benjamin; Carrié, Didier; Galinier, Michel; Bongard, Vanina; Rollin, Anne; Voisin, Sophie
• Is Part Of: Journal of arrhythmia. Volume 36:Issue 4(2020)
• Page Start: 644
• Page End: 651
• Publication Date: 2020-05-19
• Subjects: ablation -- activated clotting time -- anticoagulation -- direct oral anticoagulant; Arrhythmia -- Periodicals; Cardiac pacing -- Periodicals; Arrhythmias, Cardiac; Arrhythmia; Cardiac pacing; Periodicals; Electronic journals; Periodicals; 616.128
• DOI: 10.1002/joa3.12357
• Languages: English
• ISSNs: 1880-4276

Abstract

Abstract: Background: Anticoagulation during catheter ablation should be closely monitored with activated clotting time (ACT). However vitamin K antagonists (VKA) or direct oral anticoagulant drugs (DOAC) may act differently on ACT and on heparin needs. The aim of this study was to compare ACT and heparin requirements during catheter ablation under various oral anticoagulant drugs and in controls. Methods: Sixty consecutive patients referred for ablation were retrospectively included: group I (n = 15, VKA), group 2 (n = 15, uninterrupted rivaroxaban), group 3 (n = 15, uninterrupted apixaban), and group 4 (n = 15, controls). Heparin requirements and ACT were compared throughout the procedure. Results: Heparin requirements during the procedure were significantly lower in patients under VKA compared to DOAC, but similar between DOAC patients and controls. Activated clotting time values were significantly higher in patients under VKA compared to DOAC and similar in DOAC patients versus controls. Furthermore, anticoagulation control as evaluated by the number/proportion of ACT> 300 as well as the time passed over 300 seconds was significantly better in patients under VKA versus DOAC, without significant differences between DOAC and controls. Finally, the number of patients/ACT with excessive ACT values was significantly higher in VKA versus DOAC patients versus controls. There was no significant difference between rivaroxaban and apixaban for ACT or heparin dosing throughout the procedure. Conclusion: Vitamin K antagonists allowed less heparin requirement despite reaching higher ACT values and more efficient anticoagulation control (with more excessive values) compared to patients under DOAC therapy and to controls. There was no difference in heparin requirements or ACT between DOAC patients and controls. Abstract : VKA allowed less heparin requirement despite reaching higher ACT values and more efficient anticoagulation control (although with a higher risk for excessive values) compared to patients under long‐term direct anticoagulant therapy and to controls referred for ablation Activated clotting time may not be a sensitive marker of anticoagulation in patients under direct anticoagulant drugs and heparin