PMID- 34575348
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20211001
IS  - 2077-0383 (Print)
IS  - 2077-0383 (Electronic)
IS  - 2077-0383 (Linking)
VI  - 10
IP  - 18
DP  - 2021 Sep 18
TI  - Running after Activated Clotting Time Values in Patients Receiving Direct Oral 
      Anticoagulants: A Potentially Dangerous Race. Results from a Prospective Study in 
      Atrial Fibrillation Catheter Ablation Procedures.
LID - 10.3390/jcm10184240 [doi]
LID - 4240
AB  - BACKGROUND: Activated Clotting Time (ACT) guided heparinization is the gold 
      standard for titrating unfractionated heparin (UFH) administration during atrial 
      fibrillation (AF) ablation procedures. The current ACT target (300 s) is based on 
      studies in patients receiving a vitamin K antagonist (VKA). Several studies have 
      shown that in patients receiving Direct Oral Anticoagulants (DOACs), the 
      correlation between ACT values and UFH delivered dose is weak. OBJECTIVE: To 
      assess the relationship between ACT and real heparin anticoagulant effect 
      measured by anti-Xa activity in patients receiving different anticoagulant 
      treatments. METHODS: Patients referred for AF catheter ablation in our centre 
      were prospectively included depending on their anticoagulant type. RESULTS: 113 
      patients were included, receiving rivaroxaban (n = 30), apixaban (n = 30), 
      dabigatran (n = 30), and VKA (n = 23). To meet target ACT, a higher UFH dose was 
      required in DOAC than VKA patients (14,077.8 IU vs. 9565.2 IU, p < 0.001), 
      leading to a longer time to achieve target ACT (46.5 min vs. 27.3 min, p = 
      0.001). The correlation of ACT and anti-Xa activity was tighter in the VKA group 
      (Spearman correlation rho = 0.53), compared to the DOAC group (rho = 0.19). Despite 
      lower ACT values in the DOAC group, this group demonstrated a higher mean anti-Xa 
      activity compared to the VKA group (1.56 +/- 0.39 vs. 1.14 +/- 0.36; p = 0.002). 
      CONCLUSION: Use of a conventional ACT threshold at 300 s during AF ablation 
      procedures leads to a significant increase in UFH administration in patients 
      treated with DOACs. This increase corresponds more likely to an overdosing than a 
      real increase in UFH requirement.
FAU - Benali, Karim
AU  - Benali K
AUID- ORCID: 0000-0002-7108-3427
AD  - Departement de Cardiologie, CHRU de Nancy, 54500 Vandoeuvre les-Nancy, France.
AD  - INSERM-IADI, U1254, 54500 Vandoeuvre les-Nancy, France.
AD  - Departement de Cardiologie, CHU de Saint-Etienne, 42270 Saint-Priest-En-Jarez, 
      France.
FAU - Verain, Julien
AU  - Verain J
AD  - Departement de Cardiologie, CHRU de Nancy, 54500 Vandoeuvre les-Nancy, France.
FAU - Hammache, Nefissa
AU  - Hammache N
AD  - Departement de Cardiologie, CHRU de Nancy, 54500 Vandoeuvre les-Nancy, France.
AD  - INSERM-IADI, U1254, 54500 Vandoeuvre les-Nancy, France.
FAU - Guenancia, Charles
AU  - Guenancia C
AUID- ORCID: 0000-0002-3554-7714
AD  - Departement de Cardiologie, CHRU de Nancy, 54500 Vandoeuvre les-Nancy, France.
AD  - INSERM-IADI, U1254, 54500 Vandoeuvre les-Nancy, France.
AD  - Departement de Cardiologie, CHU de Dijon, 21000 Dijon, France.
FAU - Hooks, Darren
AU  - Hooks D
AD  - Cardiology Department, Wellington Hospital, Wellington 6021, New Zealand.
FAU - Magnin-Poull, Isabelle
AU  - Magnin-Poull I
AD  - Departement de Cardiologie, CHRU de Nancy, 54500 Vandoeuvre les-Nancy, France.
AD  - INSERM-IADI, U1254, 54500 Vandoeuvre les-Nancy, France.
FAU - Toussaint-Hacquard, Marie
AU  - Toussaint-Hacquard M
AD  - Laboratoire d'hemostase, CHRU de Nancy, 54500 Vandoeuvre les-Nancy, France.
FAU - de Chillou, Christian
AU  - de Chillou C
AUID- ORCID: 0000-0002-9025-6821
AD  - Departement de Cardiologie, CHRU de Nancy, 54500 Vandoeuvre les-Nancy, France.
AD  - INSERM-IADI, U1254, 54500 Vandoeuvre les-Nancy, France.
FAU - Sellal, Jean-Marc
AU  - Sellal JM
AUID- ORCID: 0000-0003-1080-7425
AD  - Departement de Cardiologie, CHRU de Nancy, 54500 Vandoeuvre les-Nancy, France.
AD  - INSERM-IADI, U1254, 54500 Vandoeuvre les-Nancy, France.
LA  - eng
PT  - Journal Article
DEP - 20210918
PL  - Switzerland
TA  - J Clin Med
JT  - Journal of clinical medicine
JID - 101606588
PMC - PMC8465849
OTO - NOTNLM
OT  - activated clotting time
OT  - anti-Xa activity
OT  - anticoagulation
OT  - atrial fibrillation
OT  - catheter ablation
OT  - direct oral anticoagulants
OT  - heparin
OT  - vitamin K antagonist
COIS- The authors declare no conflict of interest.
EDAT- 2021/09/29 06:00
MHDA- 2021/09/29 06:01
PMCR- 2021/09/18
CRDT- 2021/09/28 01:15
PHST- 2021/09/06 00:00 [received]
PHST- 2021/09/13 00:00 [revised]
PHST- 2021/09/15 00:00 [accepted]
PHST- 2021/09/28 01:15 [entrez]
PHST- 2021/09/29 06:00 [pubmed]
PHST- 2021/09/29 06:01 [medline]
PHST- 2021/09/18 00:00 [pmc-release]
AID - jcm10184240 [pii]
AID - jcm-10-04240 [pii]
AID - 10.3390/jcm10184240 [doi]
PST - epublish
SO  - J Clin Med. 2021 Sep 18;10(18):4240. doi: 10.3390/jcm10184240.