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Differences in activated clotting time and total unfractionated heparin dose during pulmonary vein isolation in patients on different anticoagulation therapy
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  • Ivan Zeljkovic,
  • Sandro Brusich,
  • Daniel Scherr,
  • Vedran Velagić,
  • Vassil Traykov,
  • Andrej Pernat,
  • Ante Anic,
  • Janko Szavits Nissan,
  • Matevz Jan,
  • Zoran Bakotic,
  • Vjekoslav Radeljic,
  • Ana Bojko,
  • Ivica Benko,
  • Sime Manola,
  • Nikola Pavlović
Ivan Zeljkovic
KBC Sestre Milosrdnice

Corresponding Author:[email protected]

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Sandro Brusich
Clinical Hospital Center Rijeka
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Daniel Scherr
Medical University of Graz
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Vedran Velagić
KBC Zagreb
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Vassil Traykov
Acibadem City Clinic Cardiovascular Center
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Andrej Pernat
University Medical Center Ljubljana
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Ante Anic
KBC Split
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Janko Szavits Nissan
Magdalena specijalna bolnica za kardio-vaskularnu kirurgiju i kardiologiju
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Matevz Jan
Ljubljanski Univerzitetni klinicni center
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Zoran Bakotic
Zadar General Hospital
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Vjekoslav Radeljic
KBC Sestre Milosrdnice
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Ana Bojko
KB Dubrava
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Ivica Benko
KBC Sestre Milosrdnice
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Sime Manola
KBC Sestre Milosrdnice
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Nikola Pavlović
KBC Sestre Milosrdnice
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Aims Periprocedural pulmonary vein isolation (PVI) anticoagulation requires balancing between the risk of bleeding and thromboembolism. Intraprocedural anticoagulation is monitored by activated clotting time (ACT) and there are no guidelines which specify an initial unfractionated heparin (UFH) dose. We aimed to assess differences in ACT values and UFH dosage during PVI in patients on different oral anticoagulants. Methods We conducted international, multi-centre, registry-based study. Consecutive patients with atrial fibrillation (AF) undergoing PVI, on uninterrupted anticoagulation therapy, were analysed. Before the transseptal puncture, UFH bolus of 100 U/kg was administered regardless of the anticoagulation drug. Results A total of 873 AF 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 sec, overall procedural ACT 295±45 sec 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 sec, p<0.001), (ii) significantly higher ACT throughout PVI (309±46 and 306±44 vs. 282±37 and 272±42 sec, p<0.001), 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.
Aug 2021Published in Clinical Cardiology volume 44 issue 8 on pages 1177-1182. 10.1002/clc.23681