PMID- 32012701
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20200928
IS  - 2077-0383 (Print)
IS  - 2077-0383 (Electronic)
IS  - 2077-0383 (Linking)
VI  - 9
IP  - 2
DP  - 2020 Jan 27
TI  - Activated Clotting Time Monitoring during Atrial Fibrillation Catheter Ablation: 
      Does the Anticoagulant Matter?
LID - 10.3390/jcm9020350 [doi]
LID - 350
AB  - Atrial fibrillation (AF) catheter ablation is performed in patients receiving 
      direct oral anticoagulants (DOACs) with intra-procedural unfractionated heparin 
      (UFH) administration to achieve activated clotting time (ACT) at 300 s, as for 
      vitamin K antagonist (VKA). We determined whether ACT monitoring might be 
      transposed from VKA to DOAC-treated patients. Blood was taken from 124 patients 
      receiving uninterrupted dabigatran, rivaroxaban, apixaban, or VKA or being 
      untreated. DOAC concentration or INR (VKA) were measured. ACT was determined at 
      baseline, and after spiking with UFH doses equivalent to 1000, 2500, 5000 and 
      10000 IU in vivo. At baseline, anticoagulants prolonged ACT differently, ACT was 
      longer with dabigatran and shorter with apixaban despite similar concentrations. 
      ACT strongly correlated with INR and dabigatran concentration, but not with 
      apixaban or rivaroxaban concentrations. Moreover, UFH effects on ACT prolongation 
      depended on the anticoagulant: dose-response curves in samples with VKA and 
      dabigatran were parallel whereas ACT prolongation in response to UFH was 
      significantly smaller with rivaroxaban and especially apixaban. Therefore, UFH to 
      achieve ACT at 300 s might be transposed from VKA to uninterrupted 
      dabigatran-treated patients but not to patients receiving FXa-inhibitors, 
      especially apixaban. Targeting 300 s might expose to UFH overdosing and bleeding, 
      questioning the current anticoagulation strategy.
FAU - Martin, Anne-Celine
AU  - Martin AC
AD  - Universite de Paris, Innovations Therapeutiques en Hemostase, INSERM 1140, 4 
      avenue de l'observatoire, F-75006 Paris, France.
AD  - Hopital Europeen Georges Pompidou, Service de Cardiologie, 20 Rue Leblanc, 
      F-75015 Paris, France.
FAU - Kyheng, Maeva
AU  - Kyheng M
AD  - University Lille, CHU Lille, EA 2694 - Sante publique: epidemiologie et qualite 
      des soins, 1, place de Verdun, F-59000 Lille, France.
FAU - Foissaud, Vincent
AU  - Foissaud V
AD  - Hopital d'Instruction des Armees Percy, Laboratoire de biologie, 101 avenue Henri 
      Barbusse, F-92140 Clamart, France.
FAU - Duhamel, Alain
AU  - Duhamel A
AD  - University Lille, CHU Lille, EA 2694 - Sante publique: epidemiologie et qualite 
      des soins, 1, place de Verdun, F-59000 Lille, France.
FAU - Marijon, Eloi
AU  - Marijon E
AD  - Inserm UMR-S970, Universite Paris Descartes, 56 Rue Leblanc, F-75015 Paris, 
      France.
AD  - Hopital Europeen Georges Pompidou, Service de Cardiologie, 20 Rue Leblanc, 
      F-75015 Paris, France.
FAU - Susen, Sophie
AU  - Susen S
AD  - Institut d'Hematologie-transfusion, University Lille, CHU Lille, Boulevard du Pr 
      Jules Leclercq, F-59037 Lille, France.
FAU - Godier, Anne
AU  - Godier A
AD  - Universite de Paris, Innovations Therapeutiques en Hemostase, INSERM 1140, 4 
      avenue de l'observatoire, F-75006 Paris, France.
AD  - Fondation Rothschild, Service d'Anesthesie-Reanimation, 29 rue Manin, F-75019 
      Paris, France.
LA  - eng
GR  - 00000/Societe Francaise de Cardiologie/
PT  - Journal Article
DEP - 20200127
PL  - Switzerland
TA  - J Clin Med
JT  - Journal of clinical medicine
JID - 101606588
PMC - PMC7074080
OTO - NOTNLM
OT  - activated clotting time
OT  - atrial fibrillation catheter ablation
OT  - direct oral anticoagulants
OT  - overdosing
OT  - unfractionated heparin monitoring
COIS- A.C.M.: consulting fees from Bayer-Healthcare, Boehringer-Ingelheim, consulting 
      fees and grant from Alliance Bristol-Myers-Squibb/Pfizer, and grant from the 
      Groupe de Rythmologie de la Societe Francaise de Cardiologie. E.M.: research 
      grants from Abbott, Biotronik, Boston Scientific France, Microport, Medtronic 
      France, Alliance Bristol-Myers-Squibb/Pfizer, Boehringer Ingelheim, Zoll. S.S.: 
      research grants from Carmat, CorWave, LFB-Biotechnologies, Roche, Sobi, Stago, 
      Siemens Healthineers. A.G.: honoraria and travel fees from Bayer-Healthcare, 
      Boehringer-Ingelheim, Alliance Bristol-Myers-Squibb/Pfizer and Sanofi. M.K., 
      V.F., A.D.: no conflict of interest.
EDAT- 2020/02/06 06:00
MHDA- 2020/02/06 06:01
PMCR- 2020/01/27
CRDT- 2020/02/05 06:00
PHST- 2020/01/01 00:00 [received]
PHST- 2020/01/21 00:00 [revised]
PHST- 2020/01/24 00:00 [accepted]
PHST- 2020/02/05 06:00 [entrez]
PHST- 2020/02/06 06:00 [pubmed]
PHST- 2020/02/06 06:01 [medline]
PHST- 2020/01/27 00:00 [pmc-release]
AID - jcm9020350 [pii]
AID - jcm-09-00350 [pii]
AID - 10.3390/jcm9020350 [doi]
PST - epublish
SO  - J Clin Med. 2020 Jan 27;9(2):350. doi: 10.3390/jcm9020350.