PMID- 34196416 OWN - NLM STAT- MEDLINE DCOM- 20211015 LR - 20211015 IS - 1932-8737 (Electronic) IS - 0160-9289 (Print) IS - 0160-9289 (Linking) VI - 44 IP - 8 DP - 2021 Aug TI - Differences in activated clotting time and total unfractionated heparin dose during pulmonary vein isolation in patients on different anticoagulation therapy. PG - 1177-1182 LID - 10.1002/clc.23681 [doi] AB - BACKGROUND: Periprocedural pulmonary vein isolation (PVI) anticoagulation requires balancing between bleeding and thromboembolic risk. Intraprocedural anticoagulation is monitored by activated clotting time (ACT) with target value >300 s, and there are no guidelines specifying an initial unfractionated heparin (UFH) dose. METHODS: We aimed to assess differences in ACT values and UFH dosage during PVI in patients on different oral anticoagulants. We conducted an international, multi-center, registry-based study. Consecutive patients with atrial fibrillation (AF) undergoing PVI, on uninterrupted anticoagulation therapy, were analyzed. Before transseptal puncture, UFH bolus of 100 IU/kg was administered regardless of the anticoagulation drug. RESULTS: Total of 873 patients were included (median age 61 years, IQR 53-66; female 30%). There were 248, 248, 189, 188 patients on warfarin, dabigatran, rivaroxaban, and apixaban, respectively. Mean initial ACT was 257 +/- 50 s, mean overall ACT 295 +/- 45 s and total UFH dose 158 +/- 60 IU/kg. Patients who were receiving warfarin and dabigatran compared to patients receiving rivaroxaban and apixaban had: (i) significantly higher initial ACT values (262 +/- 57 and 270 +/- 48 vs. 248 +/- 42 and 241 +/- 44 s, p < .001), (ii) significantly higher ACT throughout PVI (309 +/- 46 and 306 +/- 44 vs. 282 +/- 37 and 272 +/- 42 s, p < .001), and (iii) needed lower UFH dose during PVI (140 +/- 39 and 157 +/- 71 vs. 171 +/- 52 and 172 +/- 70 IU/kg). CONCLUSION: There are significant differences in ACT values and UFH dose during PVI in patients receiving different anticoagulants. Patients on warfarin and dabigatran had higher initial and overall ACT values and needed lower UFH dose to achieve adequate anticoagulation during PVI than patients on rivaroxaban and apixaban. CI - (c) 2021 The Authors. Clinical Cardiology published by Wiley Periodicals LLC. FAU - Zeljkovic, Ivan AU - Zeljkovic I AD - Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia. FAU - Brusich, Sandro AU - Brusich S AD - Department of Cardiology, University Hospital Centre Rijeka, Rijeka, Croatia. FAU - Scherr, Daniel AU - Scherr D AD - Department of Cardiology, Medical University Graz, Graz, Austria. FAU - Velagic, Vedran AU - Velagic V AD - Department of Cardiology, University Hospital Centre Zagreb, Zagreb, Croatia. FAU - Traykov, Vassil AU - Traykov V AD - Department of Cardiology, Acibadem City Clinic Tokuda Hospital, Sofia, Bulgaria. FAU - Pernat, Andrej AU - Pernat A AD - Department of Cardiology, University Hospital Centre Ljubljana, Ljubljana, Slovenia. FAU - Anic, Ante AU - Anic A AD - Department of Cardiology, University Hospital Centre Split, Split, Croatia. FAU - Szavits Nossan, Janko AU - Szavits Nossan J AD - Department of Cardiology, Magdalena Clinic, KrapinskeToplice, Croatia. FAU - Jan, Matevz AU - Jan M AD - Department of Cardiac Surgery, University Hospital Centre Ljubljana, Ljubljana, Slovenia. FAU - Bakotic, Zoran AU - Bakotic Z AD - Department of Cardiology, General Hospital Zadar, Zadar, Croatia. FAU - Pezo Nikolic, Borka AU - Pezo Nikolic B AD - Department of Cardiology, University Hospital Centre Zagreb, Zagreb, Croatia. FAU - Radeljic, Vjekoslav AU - Radeljic V AD - Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia. FAU - Bojko, Ana AU - Bojko A AD - Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia. FAU - Benko, Ivica AU - Benko I AD - Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia. AD - Department of Cardiology, University Hospital Dubrava, Zagreb, Croatia. FAU - Manola, Sime AU - Manola S AD - Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia. AD - Department of Cardiology, University Hospital Dubrava, Zagreb, Croatia. FAU - Pavlovic, Nikola AU - Pavlovic N AUID- ORCID: 0000-0001-9187-7681 AD - Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia. AD - Department of Cardiology, University Hospital Dubrava, Zagreb, Croatia. LA - eng PT - Journal Article DEP - 20210701 PL - United States TA - Clin Cardiol JT - Clinical cardiology JID - 7903272 RN - 0 (Anticoagulants) RN - 0 (Pyridones) RN - 9005-49-6 (Heparin) RN - 9NDF7JZ4M3 (Rivaroxaban) RN - I0VM4M70GC (Dabigatran) SB - IM MH - Aged MH - Anticoagulants/adverse effects MH - *Atrial Fibrillation/complications/diagnosis/drug therapy MH - *Catheter Ablation MH - Dabigatran/adverse effects MH - Female MH - Heparin/adverse effects MH - Humans MH - Middle Aged MH - *Pulmonary Veins/surgery MH - Pyridones/adverse effects MH - Rivaroxaban/adverse effects PMC - PMC8364723 OTO - NOTNLM OT - apixaban OT - atrial fibrillation OT - dabigatran OT - pulmonary vein isolation OT - rivaroxaban OT - warfarin COIS- The authors have no conflicts of interest to declare. EDAT- 2021/07/02 06:00 MHDA- 2021/10/16 06:00 PMCR- 2021/07/01 CRDT- 2021/07/01 08:47 PHST- 2021/06/11 00:00 [revised] PHST- 2021/03/07 00:00 [received] PHST- 2021/06/16 00:00 [accepted] PHST- 2021/07/02 06:00 [pubmed] PHST- 2021/10/16 06:00 [medline] PHST- 2021/07/01 08:47 [entrez] PHST- 2021/07/01 00:00 [pmc-release] AID - CLC23681 [pii] AID - 10.1002/clc.23681 [doi] PST - ppublish SO - Clin Cardiol. 2021 Aug;44(8):1177-1182. doi: 10.1002/clc.23681. Epub 2021 Jul 1.