PMID- 23685538
OWN - NLM
STAT- MEDLINE
DCOM- 20130826
LR  - 20130619
IS  - 1941-3084 (Electronic)
IS  - 1941-3084 (Linking)
VI  - 6
IP  - 3
DP  - 2013 Jun
TI  - Impact of international normalized ratio and activated clotting time on 
      unfractionated heparin dosing during ablation of atrial fibrillation.
PG  - 491-6
LID - 10.1161/CIRCEP.113.979088 [doi]
AB  - BACKGROUND: For ablation of atrial fibrillation, it is unclear how baseline 
      international normalized ratio (INR) affects the dosing of unfractionated heparin 
      (UFH). METHODS AND RESULTS: A retrospective review of 170 consecutive patients 
      undergoing atrial fibrillation ablation with baseline activated clotting time 
      (ACT) and INR values was performed. Patients were grouped according to INR <2.0 
      (G<2; n=129) and INR >/=2.0 (G>/=2; n=41). Clinical variables, UFH doses, and ACT 
      values were recorded. An equation was derived to calculate the first bolus of UFH 
      required to achieve an ACT >/=300 seconds, and this was subsequently assessed in 
      168 patients. For the initial 170 patients, the baseline INR (2.47+/-0.31 versus 
      1.53+/-0.31) and ACT (185+/-26 versus 153+/-30 seconds) were significantly greater in 
      G>/=2 (P<0.001). The amount of UFH to achieve the first ACT >/=300 seconds was 
      significantly higher for G<2 versus G>/=2 (9701+/-2390 versus 8268+/-2366 U; P=0.0001). 
      Baseline INR, ACT, and weight were predictors of the UFH dosage to achieve an ACT 
      >/=300 seconds. An equation derived to achieve an ACT >/=300 seconds after a single 
      bolus of UFH met this end point in 160 of 168 patients (95%). CONCLUSIONS: 
      Baseline INR and ACT, in addition to weight, are the only predictors of UFH 
      dosage needed to achieve an ACT >/=300 seconds. A derived equation predicted the 
      UFH dosage to achieve an ACT >/=300 seconds.
FAU - Hamam, Ismail
AU  - Hamam I
AD  - Division of Cardiology, Ohio State University Wexner Medical Center, Ohio State 
      University, Columbus, OH 43210, USA. Ismail.hamam@osumc.edu
FAU - Daoud, Emile G
AU  - Daoud EG
FAU - Zhang, Jianying
AU  - Zhang J
FAU - Kalbfleisch, Steven J
AU  - Kalbfleisch SJ
FAU - Augostini, Ralph
AU  - Augostini R
FAU - Winner, Marshall
AU  - Winner M
FAU - Tsai, Shane
AU  - Tsai S
FAU - Rhodes, Troy E
AU  - Rhodes TE
FAU - Houmsse, Mahmoud
AU  - Houmsse M
FAU - Liu, Zhenguo
AU  - Liu Z
FAU - Love, Charles J
AU  - Love CJ
FAU - Tyler, Jaret
AU  - Tyler J
FAU - Sachdev, Molly
AU  - Sachdev M
FAU - Weiss, Raul
AU  - Weiss R
FAU - Hummel, John D
AU  - Hummel JD
LA  - eng
PT  - Comparative Study
PT  - Journal Article
DEP - 20130517
PL  - United States
TA  - Circ Arrhythm Electrophysiol
JT  - Circulation. Arrhythmia and electrophysiology
JID - 101474365
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Atrial Fibrillation/diagnosis/*drug therapy/*surgery
MH  - Blood Coagulation/*drug effects
MH  - Catheter Ablation/adverse effects/*methods
MH  - Cohort Studies
MH  - Dose-Response Relationship, Drug
MH  - Electrocardiography/methods
MH  - Female
MH  - Follow-Up Studies
MH  - Heparin/*administration & dosage
MH  - Humans
MH  - *International Normalized Ratio
MH  - Intraoperative Care/methods
MH  - Male
MH  - Middle Aged
MH  - Multivariate Analysis
MH  - Regression Analysis
MH  - Retrospective Studies
MH  - Risk Assessment
MH  - Time Factors
MH  - Treatment Outcome
OTO - NOTNLM
OT  - anticoagulants
OT  - atrial fibrillation
OT  - catheter ablation
OT  - heparin
OT  - warfarin
EDAT- 2013/05/21 06:00
MHDA- 2013/08/27 06:00
CRDT- 2013/05/21 06:00
PHST- 2013/05/21 06:00 [entrez]
PHST- 2013/05/21 06:00 [pubmed]
PHST- 2013/08/27 06:00 [medline]
AID - CIRCEP.113.979088 [pii]
AID - 10.1161/CIRCEP.113.979088 [doi]
PST - ppublish
SO  - Circ Arrhythm Electrophysiol. 2013 Jun;6(3):491-6. doi: 
      10.1161/CIRCEP.113.979088. Epub 2013 May 17.