PMID- 29532536
OWN - NLM
STAT- MEDLINE
DCOM- 20181015
LR  - 20210109
IS  - 1932-8737 (Electronic)
IS  - 0160-9289 (Print)
IS  - 0160-9289 (Linking)
VI  - 41
IP  - 5
DP  - 2018 May
TI  - Periprocedural management of anticoagulation for atrial fibrillation catheter 
      ablation in direct oral anticoagulant-treated patients.
PG  - 646-651
LID - 10.1002/clc.22944 [doi]
AB  - BACKGROUND: Guidelines recommend performing atrial fibrillation (AF) catheter 
      ablation without interruption of a direct oral anticoagulants (DOACs) and to 
      administer unfractionated heparin (UFH) for an activated clotting time (ACT) 
      >/=300 seconds, by analogy with vitamin K antagonist (VKA). Nevertheless, 
      pharmacological differences between DOACs and VKA, especially regarding ACT 
      sensitivity and UFH response, prevent extrapolation from VKA to DOACs. 
      HYPOTHESIS: The level of anticoagulation at the time of the procedure in 
      uninterrupted DOAC-treated patients is unpredictable and would complicate 
      intraprocedural UFH administration and monitoring. METHODS: This prospective 
      study included interrupted DOAC-treated patients requiring AF ablation. 
      Preprocedural DOAC concentration ([DOAC]), intraprocedural UFH administration, 
      and ACT values were recorded. A cohort of DOAC-treated patients requiring flutter 
      catheter ablation was considered to illustrate [DOAC] without DOAC interruption. 
      RESULTS: Forty-eight patients underwent AF and 14 patients underwent flutter 
      ablation, respectively. In uninterrupted DOAC-treated patients, [DOAC] ranged 
      from </=30 to 466 ng/mL. When DOAC were interrupted, from 54 to 218 hours, [DOAC] 
      were minimal (maximum: 36 ng/mL), preventing DOAC-ACT interference. Anyway, ACT 
      values were poorly correlated with UFH doses (R (2)  = 0.2256). CONCLUSIONS: Our 
      data showed that uninterrupted DOAC therapy resulted in an unpredictable and 
      highly variable initial level of anticoagulation before catheter ablation. 
      Moreover, even with DOAC interruption preventing interference between DOAC, UFH, 
      and ACT, intraprocedural UFH monitoring was complex. Altogether, our exploratory 
      results call into question the appropriateness of transposing UFH dose protocols, 
      as well as the relevance of ACT monitoring in uninterrupted DOAC-treated 
      patients.
CI  - (c) 2018 Wiley Periodicals, Inc.
FAU - Martin, Anne-Celine
AU  - Martin AC
AUID- ORCID: 0000-0002-6148-3523
AD  - Service de Cardiologie, Service de Sante des Armees, Hopital d'Instruction des 
      Armees Percy, Clamart, France.
AD  - Faculte de Pharmacie, Inserm UMRS_1140, Universite Paris Descartes, Paris, 
      France.
FAU - Lessire, Sarah
AU  - Lessire S
AD  - Namur Thrombosis and Haemostasis Center, Department of Anesthesiology, Universite 
      Catholique de Louvain, Namur, Belgium.
FAU - Leblanc, Isabelle
AU  - Leblanc I
AD  - Service d'Anesthesie, Institut Mutualiste Montsouris, Paris, France.
AD  - Service d'Anesthesie-Reanimation, Fondation Adolphe de Rothschild, Paris, France.
FAU - Dincq, Anne-Sophie
AU  - Dincq AS
AD  - Namur Thrombosis and Haemostasis Center, Department of Anesthesiology, Universite 
      Catholique de Louvain, Namur, Belgium.
FAU - Philip, Ivan
AU  - Philip I
AD  - Service d'Anesthesie, Institut Mutualiste Montsouris, Paris, France.
FAU - Gouin-Thibault, Isabelle
AU  - Gouin-Thibault I
AD  - Faculte de Pharmacie, Inserm UMRS_1140, Universite Paris Descartes, Paris, 
      France.
AD  - Laboratoire d'Hematologie, AP-HP, Hopital Cochin, Paris, France.
AD  - Laboratoire d'Hematologie, Hopital Pontchaillou, Rennes, France.
FAU - Godier, Anne
AU  - Godier A
AD  - Faculte de Pharmacie, Inserm UMRS_1140, Universite Paris Descartes, Paris, 
      France.
AD  - Service d'Anesthesie-Reanimation, Fondation Adolphe de Rothschild, Paris, France.
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
DEP - 20180510
PL  - United States
TA  - Clin Cardiol
JT  - Clinical cardiology
JID - 7903272
RN  - 0 (Anticoagulants)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Administration, Oral
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Anticoagulants/*administration & dosage/adverse effects
MH  - Atrial Fibrillation/blood/diagnosis/physiopathology/*therapy
MH  - Atrial Flutter/blood/diagnosis/physiopathology/*therapy
MH  - Blood Coagulation/*drug effects
MH  - *Catheter Ablation/adverse effects
MH  - Drug Administration Schedule
MH  - Drug Monitoring/methods
MH  - Female
MH  - France
MH  - Heparin/*administration & dosage/adverse effects
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Prospective Studies
MH  - Time Factors
MH  - Treatment Outcome
MH  - Whole Blood Coagulation Time
PMC - PMC6489798
OTO - NOTNLM
OT  - Activated Clotting Time
OT  - Atrial Fibrillation Catheter Ablation
OT  - Direct Oral Anticoagulant
OT  - Heparin
OT  - Monitoring
COIS- A.-C.M. reports nonfinancial support from Bayer Healthcare, BMS/Pfizer, and 
      Boehringer-Ingelheim. I.G.-T. reports personal fees from Bayer Healthcare, 
      BMS/Pfizer, and Boehringer-Ingelheim. A.G. reports research grants from Conny 
      Maeva Charitable Foundation and from the French Society of Cardiology (Bourse de 
      recherche en cardiologie JESFC 2016 de la Societe Francaise de Cardiologie dotee 
      par Boehringer-Ingelheim France) during the conduct of the study, as well as 
      personal fees and nonfinancial support from Bayer Healthcare, BMS/Pfizer, and 
      Boehringer-Ingelheim. The authors declare no other potential conflicts of 
      interest.
EDAT- 2018/03/14 06:00
MHDA- 2018/10/16 06:00
PMCR- 2018/05/10
CRDT- 2018/03/14 06:00
PHST- 2017/12/24 00:00 [received]
PHST- 2018/03/06 00:00 [revised]
PHST- 2018/03/08 00:00 [accepted]
PHST- 2018/03/14 06:00 [pubmed]
PHST- 2018/10/16 06:00 [medline]
PHST- 2018/03/14 06:00 [entrez]
PHST- 2018/05/10 00:00 [pmc-release]
AID - CLC22944 [pii]
AID - 10.1002/clc.22944 [doi]
PST - ppublish
SO  - Clin Cardiol. 2018 May;41(5):646-651. doi: 10.1002/clc.22944. Epub 2018 May 10.