scholarly journals Impact of International Normalized Ratio and Activated Clotting Time on Unfractionated Heparin Dosing During Ablation of Atrial Fibrillation

2013 ◽  
Vol 6 (3) ◽  
pp. 491-496 ◽  
Author(s):  
Ismail Hamam ◽  
Emile G. Daoud ◽  
Jianying Zhang ◽  
Steven J. Kalbfleisch ◽  
Ralph Augostini ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Unfractionated Heparin ◽  
International Normalized Ratio ◽  
Clotting Time ◽  
Activated Clotting Time

scholarly journals Heparin dosing in uninterrupted anticoagulation with dabigatran vs. warfarin in atrial fibrillation ablation: RE-CIRCUIT study

EP Europace ◽  
2019 ◽  
Vol 21 (6) ◽  
pp. 879-885 ◽  
Author(s):  
Hugh Calkins ◽  
Stephan Willems ◽  
Atul Verma ◽  
Richard Schilling ◽  
Stefan H Hohnloser ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Unfractionated Heparin ◽  
Time Window ◽  
Dabigatran Etexilate ◽  
Study Drug ◽  
International Normalized Ratio ◽  
Similar Amount ◽  
Clotting Time ◽  
Bleeding Events ◽  
Activated Clotting Time

Abstract Aims To describe heparin dosing requirements in patients who underwent catheter ablation of atrial fibrillation with uninterrupted anticoagulation using dabigatran etexilate (dabigatran) or warfarin to attain therapeutic activated clotting time (ACT) in the RE-CIRCUIT® study. The RE-CIRCUIT study showed significantly fewer major bleeding events in the dabigatran vs. warfarin treatment group. Unfractionated heparin was administered during the procedure to maintain ACT >300 s. Methods and results Patients were randomly assigned to dabigatran 150 mg bid or international normalized ratio-adjusted warfarin. Ablation was performed with uninterrupted anticoagulation and continued for 8 weeks after the procedure. Heparin was administered after placement of femoral sheaths before or immediately after transseptal puncture. Ablation was performed in 635 patients (dabigatran, 317; warfarin, 318); data were available from 396 patients administered heparin (dabigatran, 191; warfarin, 205). Most frequent time window from last dose of study drug to septal puncture was 0 to <4 h in the dabigatran (41.3%) and 16 to <24 h in the warfarin arms (44.7%). Overall mean (standard deviation) heparin dose was similar between the dabigatran and warfarin groups [12 402 (10 721) vs. 11 910 (8359) IU, respectively]. Heparin dosing requirement to reach therapeutic ACT was lowest when time from last dose of dabigatran to septal puncture was 0 to <4 h. Conclusion Patients treated with dabigatran required a similar amount of unfractionated heparin as those treated with warfarin to achieve an ACT of >300 s during ablation. More heparin units were required when the time from the last dose of dabigatran to septal puncture increased.

scholarly journals Management of Intraprocedural Anticoagulation in Patients on Non-Vitamin K Antagonist Oral Anticoagulants Undergoing Catheter Ablation for Atrial Fibrillation

Circulation ◽  
2018 ◽  
Vol 138 (6) ◽  
pp. 627-633 ◽  
Author(s):  
Anne-Céline Martin ◽  
Anne Godier ◽  
Kumar Narayanan ◽  
David M. Smadja ◽  
Eloi Marijon
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Unfractionated Heparin ◽  
Vitamin K ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Vitamin K Antagonist ◽  
Clotting Time ◽  
Anticoagulation Management ◽  
Activated Clotting Time

Catheter ablation has gained a prominent role in the management of atrial fibrillation (AF), with recent data providing positive evidence on hard outcomes, including hospitalization and mortality. Ablation, however, exposes the patient to a rather unique situation, combining risks for both major bleeding and thromboembolic events. In this setting, the critical importance of rigorous anticoagulation during the procedure has been underlined, and the latest international guidelines now recommend performing AF catheter ablation with uninterrupted non-vitamin K antagonist oral anticoagulants (NOACs) and concomitant administration of unfractionated heparin adjusted to achieve and maintain a target activated clotting time of ≥300 seconds. Whereas observational studies and randomized controlled trials support the safety and efficacy of uninterrupted NOAC strategy for AF catheter ablation, recent experiences have questioned this point, showing a greater unfractionated heparin requirement in NOAC-treated patients compared with vitamin K antagonists–treated patients to achieve the target activated clotting time. Important gaps in evidence regarding optimal intraprocedural anticoagulation management need to be acknowledged. A thorough appreciation of the physiology of anticoagulation during AF catheter ablation and the relevant differences between vitamin K antagonists and NOACs is required, while also understanding the limitations of activated clotting time measurement with regard to accurate intraprocedural anticogulation monitoring. This review aims to provide a critical look at this relatively ignored aspect of AF catheter ablation, especially pitfalls in NOAC monitoring, and to identify gaps in knowledge that need to be addressed in the near future.

Variability of Activated Clotting Time by Site of Sample Draw During Percutaneous Coronary Intervention: A Prospective Single-Center Study

Angiology ◽  
2021 ◽  
pp. 000331972199223
Author(s):  
Jacqueline H. Morris ◽  
Junsoo Alex Lee ◽  
Scott McNitt ◽  
Ilan Goldenberg ◽  
Craig R. Narins
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Unfractionated Heparin ◽  
Anticoagulation Therapy ◽  
Coronary Intervention ◽  
Clotting Time ◽  
Access Sheath ◽  
Arterial Blood ◽  
Activated Clotting Time ◽  
Guide Catheter ◽  
Percutaneous Coronary

The activated clotting time (ACT) assay is used to monitor and titrate anticoagulation therapy with unfractionated heparin during percutaneous coronary intervention (PCI). Observations at our institution suggested a considerable difference between ACT values drawn from varying arterial sites, prompting the current study. Patients undergoing PCI with unfractionated heparin therapy were prospectively enrolled. Simultaneous arterial blood samples were drawn from the access sheath and the coronary guide catheter. Differences between Hemochron ACT values were determined, and potential interactions with clinical variables were analyzed. Immediately postprocedure, the simultaneous mean guide and sheath ACTs were 327 ± 62 seconds and 257 ± 44 seconds, respectively, with a mean difference of 70 ± 60 seconds (P < .001). Nearly all (90%) ACT values obtained via the guide catheter were higher than the concurrent ACT drawn from the sheath. Logistic regression analysis demonstrated that lower weight-adjusted heparin doses and absence of diabetes were associated with a greater difference between the ACT values. We conclude that the ACT value is substantially greater when assessed via the guide catheter versus the access sheath. Although the biological mechanisms require further study, this difference should be considered when managing anticoagulation during PCI and when reporting ACT as part of research protocols.

scholarly journals Activated clotting time monitoring during atrial fibrillation catheter ablation: Does the anticoagulant matter?

2020 ◽  
Vol 12 (2-4) ◽  
pp. 204
Author(s):  
A.C. Martin ◽  
M. Kyheng ◽  
V. Foissaud ◽  
A. Duhamel ◽  
E. Marijon ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Clotting Time ◽  
Activated Clotting Time

Differences in activated clotting time among uninterrupted anticoagulants during the periprocedural period of atrial fibrillation ablation

Heart Rhythm ◽  
2015 ◽  
Vol 12 (9) ◽  
pp. 1972-1978 ◽  
Author(s):  
Tomoyuki Nagao ◽  
Yasuya Inden ◽  
Satoshi Yanagisawa ◽  
Hiroyuki Kato ◽  
Shinji Ishikawa ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Atrial Fibrillation Ablation ◽  
Clotting Time ◽  
Activated Clotting Time

An in vitro method for comparing biocompatibility of materials for extracorporeal circulation

Perfusion ◽  
2002 ◽  
Vol 17 (2) ◽  
pp. 125-132 ◽  
Author(s):  
Giles J Peek ◽  
Richard Scott ◽  
Hilliary M Killer ◽  
Richard K Firmin
Keyword(s):  
International Normalized Ratio ◽  
The Other ◽  
Clotting Time ◽  
Roller Pump ◽  
In Vitro Method ◽  
Cell Counts ◽  
Activated Clotting Time ◽  
Free Haemoglobin ◽  
Group 2

We measured the response of fresh heparinized human blood to recirculation through circuits made of LVA (Portex Industries, Hythe, Kent, UK), SRT (Rehau UK, Langley, Slough, UK) and Tygon® S-65-HL (Norton Performance Plastics, Corby, Northants, UK), as control. Circuit construction: 1/2 in. tubing, heat exchanger (Dideco D-720P), Stockert roller pump, just underoccluded, Cincinnati Sub Zero heater, circuit volume of 500 ml. Flow 3.45 l/min, 37°C. Samples: at 10 min, 1, 2, 4 and 6 h. n= 5 in each group; 2/5 SRT experiments were stopped at 45 and 60 min due to overpressurization. Results: Baseline activated clotting time (ACT) of 300 s, increasing in all groups as fibrinogen fell to zero with SRT and LVA. Minimum fibrinogen was 1 g/l for Tygon. Absolute thrombocytopenia occurred (SRT and LVA 60 min and Tygon 240 min). International normalized ratio (INR) in both the SRT and LVA circuits increased, but mean increase for Tygon (0.56) was smaller than the other two materials. Plasma free haemoglobin increased in all three materials; the increase was greater in the LVA circuits compared to the control. C5b9 levels increased equally in all groups. Lactoferrin levels rose equally in all groups to a maximum at 150 min. The neutrophil counts fell, mirroring the lactoferrin. The total white cell counts also fell in all groups; in the LVA circuits, the fall was significantly lower than in the control. Rapid disappearance of platelets and fibrinogen from the blood in the SRT and LVA circuits excludes them both from extracorporeal use. Paradoxically, SRT caused the least complement activation of the three materials. This method can be used to compare biocompatibility.

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