Periprocedural Management of New Oral Anticoagulants in Patients Undergoing Atrial Fibrillation Ablation

Weitz, Jeffrey I.; Healey, Jeffrey S.; Skanes, Allan C.

doi:10.1161/circulationaha.113.005376

Cited by 21 publications

(14 citation statements)

References 23 publications

(27 reference statements)

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“…Последнюю дозу рива-роксабана обычно назначают за 24-36 ч до ка-тетерного вмешательства [27,[30][31][32]. Сведения о безопасности использования НОАК при абла-ции в данных исследованиях были противоре-чивы, но в целом вероятность развития тромбо-эмболии и риск кровотечения схожи с таковы-ми при непрерывной стратегии приема АВК [33][34][35].…”

Section: дооперационная стратегия антикоагулянтной терапииunclassified

“…Для больных, принимающих терапию дабигатраном или ри-вароксабаном, возможны либо остановка при-ема одной или двух доз до аблации, либо вы-полнение процедуры без отмены препарата (только в случае ривароксабана) [28][29][30][31][32][33][34][35][36]. Чрес-пищеводную ЭхоКГ необходимо выполнять во всех случаях, когда есть сомнения относитель-но правильности приема соответствующих ан-тикоагулянтов за 3 нед до катетерного вмеша-тельства.…”

Section: дооперационная стратегия антикоагулянтной терапииunclassified

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Application of anticoagulant therapy in patients undergoes the procedure radiofrequency catheter ablation

Филатов¹,

Goryachev²

2017

Ann aritmol

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Section: дооперационная стратегия антикоагулянтной терапииunclassified

Application of anticoagulant therapy in patients undergoes the procedure radiofrequency catheter ablation

Филатов¹,

Goryachev²

2017

Ann aritmol

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“…1 Anticoagulation is usually required during percutaneous catheter ablation procedures, because of the risk of material and lesion-induced cardiac thrombus and embolism. 2,3 This thrombo-embolic risk persists even in patients under oral anticoagulation, thus additional anticoagulation with unfractionated heparin is needed. 4 Because of combined risks of bleeding and thrombo-embolic events, it is furthermore recommended that anticoagulation levels should be closely monitored during ablation procedures: achieving and maintaining activated clotting time (ACT) > 300 seconds with heparin is currently considered mandatory for ablation of atrial fibrillation 5 and also commmonly used for ablation of ventricular arrhythmias.…”

Section: Introductionmentioning

confidence: 99%

“…4 Because of combined risks of bleeding and thrombo-embolic events, it is furthermore recommended that anticoagulation levels should be closely monitored during ablation procedures: achieving and maintaining activated clotting time (ACT) > 300 seconds with heparin is currently considered mandatory for ablation of atrial fibrillation 5 and also commmonly used for ablation of ventricular arrhythmias. 6 Activated clotting time is a widely accepted coagulation monitoring technique 3,4,7 being perfectly adapted to clinical requirements, since results are very quickly available using bedside coagulation monitoring, allowing immediate adjustment of heparin needs. 8 In patients under long-term oral anticoagulation, ablations are optimally conducted without any interruption of anticoagulant drugs.…”

Section: Introductionmentioning

confidence: 99%

“…8 In patients under long-term oral anticoagulation, ablations are optimally conducted without any interruption of anticoagulant drugs. 3 Uninterrupted use of warfarin has been previously recommended. 6 Feasibility and safety of uninterrupted direct acting oral anticoagulant (DOAC) on periprocedural periods of ablation has more recently been demonstrated [9][10][11] and is currently also recommended in the most recent guidelines.…”

Section: Introductionmentioning

confidence: 99%

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Coagulation and heparin requirements during ablation in patients under oral anticoagulant drugs

Belaid

Ribes

Voglimacci‐Stephanopoli

et al. 2020

Journal of Arrhythmia

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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.

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How minimally interrupted direct oral anticoagulants affect intraprocedural anticoagulation during atrial fibrillation ablation? Insights from a Japanese single‐center retrospective study

Mizobuchi

Funatsu

Kobayashi

et al. 2019

Journal of Arrhythmia

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Background Data are still lacking regarding the effects of minimally interrupted direct oral anticoagulants (MID) on the intensity of intraprocedural anticoagulation of atrial fibrillation (AF) ablation. Methods A total of consecutive 269 patients who undergone AF ablation were eligible for the study. All oral anticoagulants (OACs) were discontinued just one dose before the procedure except warfarin. We assessed the total required dose of UFH and time‐to‐target ACT > 300 seconds (TTA) for each of direct oral anticoagulant (DOAC) groups compared with the uninterrupted warfarin group. Results DOACs were used in 86% of the patients in the present study (dabigatran group (DG)‐17%, rivaroxaban group (RG)‐30%, apixaban group (AG)‐29%, and edoxaban group (EG)‐10%). DG and EG used comparable dose of total UFH to WG (WG vs DG; 206 ± 53 U/kg vs 231 ± 63 U/kg; P = .664, vs EG; 239 ± 67 U/kg; P = .335), while RG and AG required higher total UFH (WG vs RG; 206 ± 53 U/kg vs 270 ± 63 U/kg; P < .001, vs AG; 263 ± 62 U/kg; P < .001). TTA was significantly longer in RG (RG:73 ± 28 minutes vs WG:51 ± 25 minutes; P = .001), AG (AG:64 ± 26 minutes vs WG:51 ± 25 minutes; P = .02), and EG (EG:67 ± 34 minutes vs WG:51 ± 25 minutes; P = .02) than WG, whereas DG was comparable to WG (DG:51 ± 29 minutes vs WG:51 ± 25 minutes; P = NS). Especially, only RG demonstrated significantly slower increase in ACT than WG (P = .013). In the multivariate analysis, warfarin or dabigatran use, age > 75 years, and body weight < 60 kg are clinical predictors for achieving TTA within 60 minutes (TTA‐60). Conclusion MID‐dabigatran was comparable to uninterrupted warfarin, whereas MID‐factor Xa inhibitors were not. MID is a feasible protocol; however, we should be aware of its effect on the intraprocedural anticoagulation and differences among DOACs in the responsiveness to heparin.

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Periprocedural Management of New Oral Anticoagulants in Patients Undergoing Atrial Fibrillation Ablation

Cited by 21 publications

References 23 publications

Application of anticoagulant therapy in patients undergoes the procedure radiofrequency catheter ablation

Application of anticoagulant therapy in patients undergoes the procedure radiofrequency catheter ablation

Coagulation and heparin requirements during ablation in patients under oral anticoagulant drugs

How minimally interrupted direct oral anticoagulants affect intraprocedural anticoagulation during atrial fibrillation ablation? Insights from a Japanese single‐center retrospective study

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