Intra-procedural anticoagulation and post-procedural hemoglobin fall in atrial fibrillation ablation with minimally interrupted direct oral anticoagulants: comparisons across 4 drugs.

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Tytuł:: Intra-procedural anticoagulation and post-procedural hemoglobin fall in atrial fibrillation ablation with minimally interrupted direct oral anticoagulants: comparisons across 4 drugs.
Autorzy:: Sairaku A; Department of Cardiology, Cardiovascular Center, Onomichi General Hospital, Onomichi, Japan. .
Morishima N; Department of Cardiology, Cardiovascular Center, Onomichi General Hospital, Onomichi, Japan.
Matsumura H; Department of Cardiology, Cardiovascular Center, Onomichi General Hospital, Onomichi, Japan.
Amioka M; Department of Cardiology, Cardiovascular Center, Onomichi General Hospital, Onomichi, Japan.
Maeda J; Department of Cardiology, Cardiovascular Center, Onomichi General Hospital, Onomichi, Japan.
Watanabe Y; Department of Cardiology, Cardiovascular Center, Hiroshima General Hospital, Hatsukaichi, Japan.
Nakano Y; Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan.
Źródło:: Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing [J Interv Card Electrophysiol] 2021 Sep; Vol. 61 (3), pp. 551-557. Date of Electronic Publication: 2020 Aug 18.
Typ publikacji:: Journal Article
Język:: English
Imprint Name(s):: Publication: Amsterdam : Springer
Original Publication: Norwell, MA : Kluwer Academic Publishers, c1997-
MeSH Terms:: Atrial Fibrillation*/drug therapy
Atrial Fibrillation*/surgery
Catheter Ablation*
Pharmaceutical Preparations*
Administration, Oral ; Aged ; Anticoagulants/therapeutic use ; Dabigatran ; Hemoglobins ; Humans ; Rivaroxaban
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Cappato R, Marchlinski FE, Hohnloser SH, Naccarelli GV, Xiang J, Wilber DJ, et al. VENTURE-AF Investigators Uninterrupted rivaroxaban vs uninterrupted vitamin K antagonists for catheter ablation in non-valvular atrial fibrillation. Eur Heart J. 2015;36:1805–11. (PMID: 10.1093/eurheartj/ehv177)
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Sairaku A, Onohara Y, Hironobe N, Matsumura H, Kihara Y, Nakano Y. Remaining activity of temporary interrupted direct oral anticoagulants and its impact on intra-ablation heparinization in patients with atrial fibrillation: comparisons across four drugs and two dose regimens. J Cardiovasc Electrophysiol. 2020;27 Online ahead of print.
Contributed Indexing:: Keywords: Activated clotting time; Atrial fibrillation ablation; Direct oral anticoagulants; Hemoglobin fall
Substance Nomenclature:: 0 (Anticoagulants)
0 (Hemoglobins)
0 (Pharmaceutical Preparations)
9NDF7JZ4M3 (Rivaroxaban)
I0VM4M70GC (Dabigatran)
Entry Date(s):: Date Created: 20200819 Date Completed: 20210823 Latest Revision: 20210823
Update Code:: 20240104
DOI:: 10.1007/s10840-020-00851-6
PMID:: 32808083
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Purpose: Thromboembolic or hemorrhagic complications related to atrial fibrillation (AF) ablation are rare, and thus, it is difficult to compare their frequency across different direct oral anticoagulants (DOACs). We aimed to compare the intra-ablation blood coagulability and post-procedural hemoglobin fall as alternatives to those complications across 4 DOACs.
Methods: We enrolled AF patients younger than 65 years old in 3 cardiovascular centers who skipped a single dose of apixaban, dabigatran, edoxaban, and rivaroxaban, prior to the ablation. Endpoints included the activated clotting time (ACT), heparin requirement during the ablation, and drop in the hemoglobin level 24 h after the procedure.
Results: The time-course curves of the ACT differed significantly across the patients with apixaban (N = 113), dabigatran (N = 130), edoxaban (N = 144), and rivaroxaban (N = 81), with its highest level in the dabigatran group (P < 0.001). The average ACT was greater in the dabigatran group than in the other groups (312.3 ± 34, 334.4 ± 44, 308.1 ± 41, and 305.8 ± 34.7 s; P < 0.001). A significant difference was noted in total heparin requirement across the patient groups (3990.2 ± 1167.9, 3890.4 ± 955.3, 4423.8 ± 1051.6, and 3972 ± 978.7 U/m 2 /h; P < 0.001), with its greatest amount in the edoxaban group. The reduction in the hemoglobin level was similar (- 0.93 ± 0.92, - 0.88 ± 0.79, - 0.89 ± 0.97, - 0.95 ± 1.23 g/dL; P = 0.94). No inter-group difference was noted in the rate of major or minor bleedings (0.9%, 2.3%, 1.4%, and 3.7%; P = 0.51), and no thromboembolic events were encountered.
Conclusion: A difference in DOACs may have an impact on intra-ablation anticoagulation; however, it may not be on the procedural blood loss in the setting of a single skip.
(© 2020. Springer Science+Business Media, LLC, part of Springer Nature.)

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