Activated clotting time on the day of atrial fibrillation ablation for minimally interrupted and uninterrupted direct oral anticoagulation therapy: Sequential changes, differences among direct oral anticoagulants, and ablation safety outcomes
Activated clotting time on the day of atrial fibrillation ablation for minimally interrupted and uninterrupted direct oral anticoagulation therapy: Sequential changes, differences among direct oral anticoagulants, and ablation safety outcomes
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DOI：
10.1111/jce.14260
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发表时间：
2019-11-12
影响因子：
2.7
通讯作者：
Kusachi, Shozo
中科院分区：
文献类型：
--
作者：
Yamaji, Hirosuke;Murakami, Takashi;Kusachi, Shozo
活化凝血时间（ACT）引导的肝素化用于房颤（AF）消融。不同的直接口服抗凝剂（DOACs）对ACT检测的敏感性存在差异。目的：研究不同消融开始时间（9:00、11:00、13:00或15:00）的消融前ACT （pre-ACT）和最小中断（min-Int）和不间断（Unint） DOAC方案的消融安全性，并研究四种DOAC方案中pre-ACT值的差异。方法将连续患者随机分为min-Int组（307例）和Unint组（277例）。检查的doac为阿哌沙班、达比加群、依多沙班和利伐沙班。结果在min-Int组和Unint组中，每种DOAC和所有四种DOAC联合使用的act前值均未观察到顺序变化。各组间消融起始时间前act无显著差异。两组间总体act前时间未见临床显著差异（138 +/- 24秒vs 142 +/- 23秒）。达比加群的act前（基线）值比其他三种doac平均高29秒。min-Int组和Unint组显示相似的血栓栓塞（0% vs 0%）和出血事件发生率（主要，1% vs 0%；全部，3.5% vs 2.5%）。结论pre-ACT在min-Int组和Unint组中没有顺序变化。两组间pre-ACT的时间依赖性变化无显著差异。基线ACT的变化表明需要适度调整ACT以充分调整其他三种doac的肝素剂量。两种方案提供了相似的可接受心房颤动消融安全性结果。
Background Activated clotting time (ACT)-guided heparinization is used during atrial fibrillation (AF) ablation. Differences in sensitivity to ACT assays have been identified among different direct oral anticoagulants (DOACs). Objective We aimed to examine ACT just before ablation (pre-ACT) for different ablation start times (9:00, 11:00, 13:00, or 15:00) and ablation safety outcomes in minimally interrupted (min-Int) and uninterrupted (Unint) DOAC regimens and examine differences in pre-ACT values among four DOACs. Methods Consecutive patients were randomized into the min-Int (n = 307) or Unint (n = 277) groups. DOACs examined were apixaban, dabigatran, edoxaban, and rivaroxaban. Results No sequential changes in pre-ACT values were observed for each DOAC used and for all four DOACs combined in the min-Int and Unint groups. There was no meaningful difference in pre-ACT at each ablation start time between the groups. Clinically significant differences in overall pre-ACT were not obtained between the groups (138 +/- 24 vs 142 +/- 23 seconds). The pre-ACT (baseline) value for dabigatran was on average 29 seconds higher than that for the other three DOACs. The min-Int and Unint groups showed similar thromboembolic (0% vs 0%) and bleeding event rates (major, 1% vs 0%; all, 3.5% vs 2.5%). Conclusion The pre-ACT did not show a sequential change in the min-Int and Unint groups. No notable differences in the time-dependent change in pre-ACT between the groups were observed. Variations in baseline ACT suggest the need for moderate adjustment of ACT for adequate modification of heparin dose for the other three DOACs. Both regimens provided similar acceptable AF ablation safety outcomes.