PMID- 28401863
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20200930
IS  - 0972-6292 (Print)
IS  - 0972-6292 (Electronic)
IS  - 0972-6292 (Linking)
VI  - 16
IP  - 6
DP  - 2016 Nov-Dec
TI  - Real-life experience with a new anticoagulation regimen for patients undergoing 
      left-sided ablation procedures.
PG  - 181-184
LID - S0972-6292(16)31308-0 [pii]
LID - 10.1016/j.ipej.2016.10.011 [doi]
AB  - BACKGROUND: Current guidelines for anticoagulation during left-sided procedures 
      recommend the administration of unfractionated heparin (UFH) with an initial 
      bolus of 50-100 U/kg, followed by continuous infusion to maintain an activated 
      clotting time (ACT) >/= 300 s. Our objective was to compare the effectiveness of 
      this standard regimen (100 U/kg bolus) to a more aggressive approach (200 U/kg 
      bolus). METHODS: We collected data on a series of consecutive patients undergoing 
      left sided ablation procedures. Patients with an INR >/=2.0 on the day of the 
      procedure were excluded. Procedural anticoagulation was performed using one of 
      two UFH regimens: 1) 100 U/kg bolus, followed by 10 U/kg/hour infusion or 2) 
      200 U/kg bolus, followed by 20 U/kg/hour infusion. ACT was measured 10 min after 
      the second bolus and then controlled every 20 min. Heparin was titrated 
      throughout the procedure to maintain an ACT 300-400 s. RESULTS: 145 consecutive 
      patients were included in the study: 34 received an initial bolus of 100 U/kg and 
      111 received 200 U/kg. The mean time required to reach an ACT >/=300 s was 
      15.25 min (95% CI 12.97-17.03) in the 200 U/kg group and 51.23 min (95% CI 
      40.65-61.81) in the 100 U/kg group (p < 0.001). There was no difference between 
      groups with regard to thromboembolic or hemorrhagic complications. CONCLUSION: 
      Current anticoagulation guidelines for left-sided ablation procedures almost 
      universally fail to achieve an initial ACT >/=300 s. A 200 U/kg heparin bolus is 
      much more effective to promptly reach the target ACT, with a low rate of 
      overshoot.
CI  - Copyright (c) 2016 Indian Heart Rhythm Society. Production and hosting by Elsevier 
      B.V. All rights reserved.
FAU - Dussault, Charles
AU  - Dussault C
AD  - Centre Hospitalier Universitaire de Sherbroke, Sherbrooke, Quebec, Canada. 
      Electronic address: charles.dussault@usherbrooke.ca.
FAU - Rivera, Santiago
AU  - Rivera S
AD  - Centre Hospitalier Universitaire de Sherbroke, Sherbrooke, Quebec, Canada.
FAU - Badra-Verdu, Mariano
AU  - Badra-Verdu M
AD  - Centre Hospitalier Universitaire de Sherbroke, Sherbrooke, Quebec, Canada.
FAU - Ayala-Paredes, Felix
AU  - Ayala-Paredes F
AD  - Centre Hospitalier Universitaire de Sherbroke, Sherbrooke, Quebec, Canada.
FAU - Roux, Jean-Francois
AU  - Roux JF
AD  - Centre Hospitalier Universitaire de Sherbroke, Sherbrooke, Quebec, Canada.
LA  - eng
PT  - Journal Article
DEP - 20161021
PL  - Netherlands
TA  - Indian Pacing Electrophysiol J
JT  - Indian pacing and electrophysiology journal
JID - 101157207
PMC - PMC5219824
OTO - NOTNLM
OT  - Ablation
OT  - Arrhythmia
OT  - Heparin
EDAT- 2017/04/13 06:00
MHDA- 2017/04/13 06:01
PMCR- 2016/10/21
CRDT- 2017/04/13 06:00
PHST- 2016/07/14 00:00 [received]
PHST- 2016/10/21 00:00 [accepted]
PHST- 2017/04/13 06:00 [entrez]
PHST- 2017/04/13 06:00 [pubmed]
PHST- 2017/04/13 06:01 [medline]
PHST- 2016/10/21 00:00 [pmc-release]
AID - S0972-6292(16)31308-0 [pii]
AID - 10.1016/j.ipej.2016.10.011 [doi]
PST - ppublish
SO  - Indian Pacing Electrophysiol J. 2016 Nov-Dec;16(6):181-184. doi: 
      10.1016/j.ipej.2016.10.011. Epub 2016 Oct 21.