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Differences in intraprocedural ACTs with standardized heparin dosing during catheter ablation for atrial fibrillation in patients treated with dabigatran vs. patients on uninterrupted warfarin.
MedLine Citation:
PMID:  23015216     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
PURPOSE: Effective intraprocedural anticoagulation for catheter ablation for atrial fibrillation is critical to minimize the risk of cerebral thromboembolism. The effect of dabigatran on anticoagulation with heparin during the procedure is unknown. This study compares heparin anticoagulation in patients treated with dabigatran vs. patients on uninterrupted warfarin. METHODS: Seventy-six consecutive patients (24 dabigatran and 52 warfarin) subjected to a standard intraprocedural heparin protocol were included. Heparin administration and rapidity and degree of anticoagulation were compared between the groups. RESULTS: Despite greater administration of heparin (52.5 ± 22.0 vs. 33.2 ± 10.1 units kg(-1) h(-1); p < 0.001), the mean (320.3 ± 19.5 s) and peak (358.8 ± 28.6 s) activated clotting time (ACT) for the dabigatran group were significantly lower than for the warfarin group (mean, 362.9 ± 35.9 and peak, 410.4 ± 49.7; p < 0.001). The time from initial heparin bolus to first ACT of ≥300 s in the dabigatran group was more than twice that observed in the warfarin group (45.0 ± 30.4 vs. 20.9 ± 14.5 min; p < 0.001). The time to first ACT of ≥350 s was similarly prolonged (109.1 ± 60.0 vs. 55.2 ± 51.1 min; p < 0.001) in the dabigatran group, with eight patients (33 %) failing to reach this target. Outcome differences persisted following analysis using linear models and Cox proportional hazard regression with adjustment for propensity scores. CONCLUSION: A standard intraprocedural heparin protocol results in delayed and lower levels of anticoagulation as measured by the ACT for patients treated with dabigatran compared with those on uninterrupted warfarin.
Authors:
Sai V Konduru; Aamir A Cheema; Philip Jones; Yan Li; Brian Ramza; Alan P Wimmer
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-9-27
Journal Detail:
Title:  Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing     Volume:  -     ISSN:  1572-8595     ISO Abbreviation:  J Interv Card Electrophysiol     Publication Date:  2012 Sep 
Date Detail:
Created Date:  2012-9-27     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9708966     Medline TA:  J Interv Card Electrophysiol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Saint Luke's Mid America Heart Institute, University of Missouri Kansas City, 4330 Wornall Road, Suite 2000, Kansas City, MO, 64111, USA.
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