PMID- 35425821
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220423
IS  - 2297-055X (Print)
IS  - 2297-055X (Electronic)
IS  - 2297-055X (Linking)
VI  - 9
DP  - 2022
TI  - Uninterrupted DOACs Approach for Catheter Ablation of Atrial Fibrillation: Do 
      DOACs Levels Matter?
PG  - 864899
LID - 10.3389/fcvm.2022.864899 [doi]
LID - 864899
AB  - Most patients present for catheter ablation of atrial fibrillation (CAAF) with 
      residual or full effect of vitamin K antagonists (VKAs) or direct oral 
      anticoagulants (DOACs). In daily practice, it has been observed that the 
      activated clotting time (ACT) was actually poorly sensitive to the effect of 
      DOACs and that patients on DOACs required more unfractionated heparin (UFH) to 
      achieve the ACT target of 300 s during the procedure, leading some authors to 
      worry about potential overdosing. Conversely, we hypothesize that these higher 
      doses of UFH are necessary to achieve adequate hemostasis during CAAF regardless 
      of the residual effect of DOACs. During CAAF, thrombosis is promoted mainly by 
      the presence of thrombogenic sheaths and catheters in the bloodstream. 
      Preclinical data suggest that only high doses of DOACs are able to mitigate 
      catheter-induced thrombin generation, whereas low dose UFH already do so. In 
      addition, the effect of UFH seems to be lower in patients on DOACs, compared to 
      patients on VKAs, explaining part of the differences observed in heparin 
      requirements. Clinical studies could not identify increased bleeding risk in 
      patients on DOACs compared to those on VKAs despite similar efficacy during CAAF 
      procedures. Moreover, targeting a lower ACT was associated with an increased 
      periprocedural thrombotic risk for both DOAC and VKA patients. Therefore, the low 
      sensitivity of the ACT to the residual effect of DOACs should not be a major 
      concern in its use in the interventional cardiology laboratory.
CI  - Copyright (c) 2022 Hardy, Douxfils, Dincq, Sennesael, Xhaet, Mullier and Lessire.
FAU - Hardy, Michael
AU  - Hardy M
AD  - Universite catholique de Louvain, Hematology Laboratory, Namur Thrombosis and 
      Hemostasis Center, Namur Research Institute for Life Sciences, Centre Hospitalier 
      Universitaire UCL Namur, Namur, Belgium.
AD  - Universite catholique de Louvain, Department of Anesthesiology, Namur Thrombosis 
      and Hemostasis Center, Namur Research Institute for Life Sciences, Centre 
      Hospitalier Universitaire UCL Namur, Namur, Belgium.
FAU - Douxfils, Jonathan
AU  - Douxfils J
AD  - Department of Pharmacy, Namur Thrombosis and Hemostasis Center, Namur Research 
      Institute for LIfe Sciences, University of Namur, Namur, Belgium.
AD  - QUALIblood s.a., Namur, Belgium.
FAU - Dincq, Anne-Sophie
AU  - Dincq AS
AD  - Universite catholique de Louvain, Department of Anesthesiology, Namur Thrombosis 
      and Hemostasis Center, Namur Research Institute for Life Sciences, Centre 
      Hospitalier Universitaire UCL Namur, Namur, Belgium.
FAU - Sennesael, Anne-Laure
AU  - Sennesael AL
AD  - Universite catholique de Louvain, Pharmacy Department, Namur Thrombosis and 
      Hemostasis Center, Namur Research Institute for Life Sciences, Centre Hospitalier 
      Universitaire UCL Namur, Namur, Belgium.
FAU - Xhaet, Olivier
AU  - Xhaet O
AD  - Universite catholique de Louvain, Department of Cardiology, Namur Thrombosis and 
      Hemostasis Center, Centre Hospitalier Universitaire UCL Namur, Namur, Belgium.
FAU - Mullier, Francois
AU  - Mullier F
AD  - Universite catholique de Louvain, Hematology Laboratory, Namur Thrombosis and 
      Hemostasis Center, Namur Research Institute for Life Sciences, Centre Hospitalier 
      Universitaire UCL Namur, Namur, Belgium.
FAU - Lessire, Sarah
AU  - Lessire S
AD  - Universite catholique de Louvain, Department of Anesthesiology, Namur Thrombosis 
      and Hemostasis Center, Namur Research Institute for Life Sciences, Centre 
      Hospitalier Universitaire UCL Namur, Namur, Belgium.
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20220329
PL  - Switzerland
TA  - Front Cardiovasc Med
JT  - Frontiers in cardiovascular medicine
JID - 101653388
PMC - PMC9001940
OTO - NOTNLM
OT  - activated clotting time
OT  - atrial fibrillation
OT  - catheter ablation
OT  - direct oral anticoagulant
OT  - unfractionated heparin
COIS- JD is the CEO and founder of QUALIblood s.a., a contract research organization 
      manufacturing the DP-Filter, is a coinventor of the DP-Filter (patent application 
      number: PCT/ET2019/052903) and reports personal fees from Daiichi-Sankyo, Mithra 
      Pharmaceuticals, Stago, Roche and Roche Diagnostics outside the submitted work. 
      FM reports institutional fees from Stago, Werfen, Nodia, Roche Sysmex and Bayer. 
      He also reports speaker fees from Boehringer Ingelheim, Bayer Healthcare, 
      Bristol-Myers Squibb, Pfizer, Stago, Sysmex and Aspen all outside the submitted 
      work. The remaining authors declare that the research was conducted in the 
      absence of any commercial or financial relationships that could be construed as a 
      potential conflict of interest.
EDAT- 2022/04/16 06:00
MHDA- 2022/04/16 06:01
PMCR- 2022/01/01
CRDT- 2022/04/15 05:32
PHST- 2022/01/29 00:00 [received]
PHST- 2022/02/28 00:00 [accepted]
PHST- 2022/04/15 05:32 [entrez]
PHST- 2022/04/16 06:00 [pubmed]
PHST- 2022/04/16 06:01 [medline]
PHST- 2022/01/01 00:00 [pmc-release]
AID - 10.3389/fcvm.2022.864899 [doi]
PST - epublish
SO  - Front Cardiovasc Med. 2022 Mar 29;9:864899. doi: 10.3389/fcvm.2022.864899. 
      eCollection 2022.