학술논문
Abstract 14325: Uninterrupted Apixaban Increases Intraprocedural Heparin Requirement During Catheter Ablation of Atrial Fibrillation
Document Type
Article
Author
Hyson, Peter; Zipse, Matthew; Charlton, Amanda; Trujillo, Toby; Shakowski, Courtney; Page, Robert L; Fleeman, Blake; Mantini, Nicholas; Miller, Brian; Chang, Shu; Aleong, Ryan G; Borne, Ryan; Nguyen, Duy; Rosenberg, Michael; Sandhu, Amneet; Sauer, William; Schuller, Joseph; Tompkins, Christine; Varosy, Paul D; Tzou, Wendy S; Tumolo, Alexis Z
Source
Circulation (Ovid); November 2019, Vol. 140 Issue: Supplement 1 pA14325-A14325, 1p
Subject
Language
ISSN
00097322; 15244539
Abstract
Introduction:Therapeutic heparinization during catheter ablation of atrial fibrillation (AF) is critical to reducing the risk of periprocedural stroke. Patients on uninterrupted direct oral anticoagulants (DOACs) may require adjusted dosing of heparin compared to warfarin, and delays in reaching therapeutic ACTs due to heparin underdosing could increase potential for adverse events. We sought to evaluate the effects of Apixaban (A), Dabigatran (D), Rivaroxaban (R), and Warfarin (W) on intraprocedural heparin dosing in AF ablation.Methods:256 consecutive patients undergoing AF ablation on uninterrupted DOAC or W were identified. Procedural details with heparin dosing and ACTs were collected. Statistical analysis was performed utilizing one-way ANOVA with pairwise comparisons of results by the Tukey post hoc test.Results:The mean age was 64, and 97/256 (38%) were female. AC therapy included: A(n=35), D(n=142), R(n=25), and W(n=54). Mean baseline ACT was lowest for A(147 s) and R(157 s), versus D(212 s) and W(209 s) (p< 0.05). High outlier baseline ACTs were observed in 5 Dpatients (445-582 s). Time to achieve target ACT (>350s) was longest for A(130.5 min), compared to R(76.5 min), D(70.8 min), and W(71.3 min) (p< 0.05). Heparin required to achieve therapeutic ACT was highest in A(259.8 u/kg) compared to R(197.2 u/kg), D(165.4 u/kg), and W(184.2 u/kg) (p < 0.05); total intraprocedural heparin was also highest in A (352.8 u/kg) compared to R (313.5 u/kg), D (293.8 u/kg) and W (260.6 u/kg) (p < 0.05).19 patients never achieved target ACT: A8.6%, D6.3%, R0%, and W7.5%.Conclusions:In comparison with D, W, and R, use of Arequired more (>30u/kg) intraprocedural heparin with delay in reaching target ACT.Use of Ralso showed nonsignificant trend toward higher time to therapeutic ACT and higher heparin use. This suggests a class effect of uninterrupted Xa-inhibitors on therapeutic AC with heparin which merits further study and DOAC-specific heparin dosing protocols.