PMID- 33476459
OWN - NLM
STAT- MEDLINE
DCOM- 20210809
LR  - 20210809
IS  - 1540-8167 (Electronic)
IS  - 1045-3873 (Linking)
VI  - 32
IP  - 3
DP  - 2021 Mar
TI  - Protocol driven periprocedural anticoagulation for left atrial ablation.
PG  - 639-646
LID - 10.1111/jce.14892 [doi]
AB  - INTRODUCTION: A weight-based heparin dosing policy adjusted for preprocedural 
      oral anticoagulation was implemented to reduce the likelihood of subtherapeutic 
      dosing during left atrial catheter ablation procedures. We hypothesized that 
      initiation of the protocol would result in a greater prevalence of therapeutic 
      activated clotting time (ACT) values and decreased time to therapeutic ACT during 
      left atrial ablation procedures. METHODS: A departmental protocol was initiated 
      for which subjects received intravenous unfractionated heparin (UFH) to achieve 
      and maintain a goal of ACT >300 s. Initial bolus dose was adjusted for 
      pre-procedure oral anticoagulation and weight as follows: 50 units/kg for those 
      receiving warfarin, 75 units/kg for those not anticoagulated, and 120 units/kg 
      for those on direct oral anticoagulants (DOACs). A UFH infusion was initiated at 
      10% of the bolus per hour. One hundred consecutive left atrial ablation 
      procedures treated with Protocol Guided heparin dosing were compared with a 
      retrospective consecutive cohort of Usual Care heparin dosing. RESULTS: When the 
      Usual Care and Protocol Guided cohorts were compared, significant findings were 
      limited to those on pre-procedure DOAC. The initial UFH bolus increased from 
      99.3 +/- 24.8 to 118.2 +/- 22.8 units/kg (p < .001), the proportion of therapeutic 
      ACT on the first draw after heparin administration increased from 57.7% to 76.6% 
      (p = .010), and the time to therapeutic ACT after UFH administration decreased 
      from 37.8 +/- 19.8 to 30.2 +/- 16.4 min (p = .032). CONCLUSION: A weight-based 
      protocol for periprocedural UFH administration resulted in a higher proportion of 
      therapeutic ACT values and decreased the time to therapeutic ACT for those on 
      pre-procedure DOAC.
CI  - (c) 2021 Wiley Periodicals LLC.
FAU - Bradley, Christopher J
AU  - Bradley CJ
AD  - Department of Cardiovascular Medicine, Oakland University William Beaumont School 
      of Medicine, Royal Oak, Michigan, USA.
FAU - Williamson, Brian D
AU  - Williamson BD
AD  - Department of Cardiovascular Medicine, Oakland University William Beaumont School 
      of Medicine, Royal Oak, Michigan, USA.
FAU - George, Julie
AU  - George J
AD  - Department of Cardiovascular Medicine, Oakland University William Beaumont School 
      of Medicine, Royal Oak, Michigan, USA.
FAU - Haines, David E
AU  - Haines DE
AUID- ORCID: 0000-0002-5592-8338
AD  - Department of Cardiovascular Medicine, Oakland University William Beaumont School 
      of Medicine, Royal Oak, Michigan, USA.
LA  - eng
PT  - Journal Article
DEP - 20210202
PL  - United States
TA  - J Cardiovasc Electrophysiol
JT  - Journal of cardiovascular electrophysiology
JID - 9010756
RN  - 0 (Anticoagulants)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Anticoagulants/adverse effects
MH  - *Atrial Fibrillation/diagnosis/drug therapy/surgery
MH  - *Catheter Ablation/adverse effects
MH  - Heparin/adverse effects
MH  - Humans
MH  - Retrospective Studies
OTO - NOTNLM
OT  - anticoagulation
OT  - atrial fibrillation
OT  - catheter ablation
OT  - quality improvement
EDAT- 2021/01/22 06:00
MHDA- 2021/08/10 06:00
CRDT- 2021/01/21 17:14
PHST- 2020/08/10 00:00 [received]
PHST- 2020/12/04 00:00 [revised]
PHST- 2021/01/02 00:00 [accepted]
PHST- 2021/01/22 06:00 [pubmed]
PHST- 2021/08/10 06:00 [medline]
PHST- 2021/01/21 17:14 [entrez]
AID - 10.1111/jce.14892 [doi]
PST - ppublish
SO  - J Cardiovasc Electrophysiol. 2021 Mar;32(3):639-646. doi: 10.1111/jce.14892. Epub 
      2021 Feb 2.