PMID- 33749350
OWN - NLM
STAT- MEDLINE
DCOM- 20220114
LR  - 20220114
IS  - 1940-4034 (Electronic)
IS  - 1074-2484 (Linking)
VI  - 26
IP  - 4
DP  - 2021 Jul
TI  - Comprehensive Intraprocedural Unfractionated Heparin Protocol During Catheter 
      Ablation of Atrial Fibrillation in the Presence of Direct Oral Anticoagulants and 
      Wide Spectrum of Body Mass Index.
PG  - 349-358
LID - 10.1177/1074248421998492 [doi]
AB  - INTRODUCTION: Data on optimal dosing of unfractionated heparin (UFH) in the 
      presence of a direct oral anticoagulant (DOAC) to achieve and maintain an 
      activated clotting time (ACT) of >/=300 seconds during catheter ablation of atrial 
      fibrillation (CA-AF) are limited and prevalence of obesity adds to the 
      unpredictable response to UFH. METHODS AND RESULTS: One hundred seventeen 
      consecutive patients undergoing CA-AF were prospectively administered 
      weight-adjusted, weight-based UFH using a pre-specified detailed protocol and 
      retrospectively analyzed. Due to lack of distribution of UFH into muscle or 
      adipose tissue and lower degree of vascularity in the latter compartment, each 
      patient's ideal and actual weights were used to determine the adjusted-weight for 
      use in all UFH doses. A UFH bolus of 200 units/kg was administered intravenously 
      followed by an infusion of 35 units/kg/hour. The mean age was 65 years, and 85 
      patients (72.6%) were male. The average body mass index (BMI) was 30 (range 
      18-50) kg/m(2). After the initial UFH bolus dose, 99 patients (84.6%) achieved 
      ACT >/=300 sec with a mean (+/- SD) of 380 +/- 79 sec. The mean time to reach an ACT 
      >/=300 in all patients was 14.6 +/- 12.4 minutes. Among all measured ACT values, 423 
      (90.8%) were >/=300 seconds. These results were consistent within all BMI 
      categories. There were no intraprocedural thrombotic or hemorrhagic 
      complications. Two patients (1.7%) sustained groin vascular access site hematoma 
      without subsequent intervention and 7 patients (6%) experienced minor oozing 
      post-procedurally. CONCLUSIONS: Our comprehensive weight-adjusted, weight-based 
      UFH protocol, during CA-AF in presence of a DOAC, rapidly achieved and maintained 
      an effective ACT irrespective of BMI.
FAU - Safani, Michael
AU  - Safani M
AUID- ORCID: 0000-0001-9687-7488
AD  - Department of Pharmacy Services / MemorialCare Heart & Vascular Institute, Long 
      Beach, CA, USA.
AD  - University of California, San Francisco, CA, USA.
FAU - Tobias, Serge
AU  - Tobias S
AD  - 323637MemorialCare Heart & Vascular Institute, Long Beach, CA, USA.
AD  - University of California, Irvine, CA, USA.
FAU - Shandling, Adrian H
AU  - Shandling AH
AD  - 323637MemorialCare Heart & Vascular Institute, Long Beach, CA, USA.
AD  - University of California, Irvine, CA, USA.
FAU - Redmond, Kathryn
AU  - Redmond K
AD  - 323637MemorialCare Heart & Vascular Institute, Long Beach, CA, USA.
FAU - Lee, Mark Young
AU  - Lee MY
AD  - 323637MemorialCare Heart & Vascular Institute, Long Beach, CA, USA.
AD  - University of California, Irvine, CA, USA.
LA  - eng
PT  - Journal Article
DEP - 20210322
PL  - United States
TA  - J Cardiovasc Pharmacol Ther
JT  - Journal of cardiovascular pharmacology and therapeutics
JID - 9602617
RN  - 0 (Factor Xa Inhibitors)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Atrial Fibrillation/*therapy
MH  - Body Mass Index
MH  - Body Weight
MH  - Catheter Ablation/*methods
MH  - Clinical Protocols/*standards
MH  - Dose-Response Relationship, Drug
MH  - Factor Xa Inhibitors/*administration & dosage
MH  - Female
MH  - Heparin/*administration & dosage/therapeutic use
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Prospective Studies
MH  - Retrospective Studies
OTO - NOTNLM
OT  - activated clotting time
OT  - atrial fibrillation
OT  - body mass index
OT  - catheter ablation
OT  - direct oral anticoagulant
OT  - hemorrhagic
OT  - thrombotic
OT  - unfractionated heparin
EDAT- 2021/03/23 06:00
MHDA- 2022/01/15 06:00
CRDT- 2021/03/22 12:24
PHST- 2021/03/23 06:00 [pubmed]
PHST- 2022/01/15 06:00 [medline]
PHST- 2021/03/22 12:24 [entrez]
AID - 10.1177/1074248421998492 [doi]
PST - ppublish
SO  - J Cardiovasc Pharmacol Ther. 2021 Jul;26(4):349-358. doi: 
      10.1177/1074248421998492. Epub 2021 Mar 22.