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Protocol Driven Peri-Procedural Anticoagulation for Left Atrial Ablation
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  • Christopher Bradley,
  • Brian Williamson,
  • Julie George,
  • David Haines
Christopher Bradley
Beaumont Health System

Corresponding Author:[email protected]

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Brian Williamson
Beaumont Health System
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Julie George
Beaumont Health System
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David Haines
Beaumont Health System
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Introduction: A weight-based heparin dosing policy that adjusted for pre-procedural oral anticoagulation was implemented to reduce the likelihood of sub-therapeutic dosing during left atrial catheter ablation procedures. Our hypothesis was that initiation of the protocol would result in a greater prevalence of therapeutic Activated Clotting Time (ACT) values and decreased time to therapeutic ACT during left atrial ablation procedures. Methods: A departmental protocol was initiated for which subjects received intravenous unfractionated heparin (UFH) to achieve and maintain a goal of ACT >300 seconds. Initial bolus dose was adjusted for pre-procedure oral anticoagulation and weight as follows: 50 units/kg for those receiving warfarin, 75 units/kg for those not anticoagulated, and 120 units/kg for those on direct oral anticoagulants. An UFH infusion was initiated at 10% of the bolus per hour. An observational study was performed on 100 consecutive left atrial ablation procedures with usual care, versus 100 with protocol guided peri-procedural care. Results: When usual care and protocol guided cohorts were compared, significant findings were limited to those on pre-procedure direct oral anticoagulant (DOAC). The initial UFH bolus increased from 97±29 units/Kg to 113±29 units/Kg (p<0.001), the proportion of therapeutic ACT on first draw after heparin administration increased from 58% to 77% (p=0.010), and the time to therapeutic ACT after UFH administration decreased from 37.8±19.8 minutes to 30.2±16.4 minutes (p=0.032). Conclusion: A weight-based protocol for peri-procedural UFH administration resulted in a higher proportion of therapeutic ACT values and decreased the time to therapeutic ACT for those on pre-procedure DOAC.
10 Aug 2020Submitted to Journal of Cardiovascular Electrophysiology
11 Aug 2020Submission Checks Completed
11 Aug 2020Assigned to Editor
12 Aug 2020Reviewer(s) Assigned
26 Aug 2020Review(s) Completed, Editorial Evaluation Pending
28 Aug 2020Editorial Decision: Revise Minor
19 Nov 20201st Revision Received
07 Dec 2020Submission Checks Completed
07 Dec 2020Assigned to Editor
07 Dec 2020Reviewer(s) Assigned
15 Dec 2020Review(s) Completed, Editorial Evaluation Pending
02 Jan 2021Editorial Decision: Accept
21 Jan 2021Published in Journal of Cardiovascular Electrophysiology. 10.1111/jce.14892