Running after Activated Clotting Time Values in Patients Receiving Direct Oral Anticoagulants: A Potentially Dangerous Race. Results from a Prospective Study in Atrial Fibrillation Catheter Ablation Procedures
Background: Activated Clotting Time (ACT) guided heparinization is the gold standard for titrating unfractionated heparin (UFH) administration during atrial fibrillation (AF) ablation procedures. The current ACT target (300 s) is based on studies in patients receiving a vitamin K antagonist (VKA). S...
Main Authors: | , , , , , , , , |
---|---|
Format: | Article |
Language: | English |
Published: |
MDPI AG
2021-09-01
|
Series: | Journal of Clinical Medicine |
Subjects: | |
Online Access: | https://www.mdpi.com/2077-0383/10/18/4240 |
id |
doaj-2930737060b242d889ab183293cb30ca |
---|---|
record_format |
Article |
spelling |
doaj-2930737060b242d889ab183293cb30ca2021-09-26T00:28:45ZengMDPI AGJournal of Clinical Medicine2077-03832021-09-01104240424010.3390/jcm10184240Running after Activated Clotting Time Values in Patients Receiving Direct Oral Anticoagulants: A Potentially Dangerous Race. Results from a Prospective Study in Atrial Fibrillation Catheter Ablation ProceduresKarim Benali0Julien Verain1Nefissa Hammache2Charles Guenancia3Darren Hooks4Isabelle Magnin-Poull5Marie Toussaint-Hacquard6Christian de Chillou7Jean-Marc Sellal8Département de Cardiologie, CHRU de Nancy, 54500 Vandœuvre lès-Nancy, FranceDépartement de Cardiologie, CHRU de Nancy, 54500 Vandœuvre lès-Nancy, FranceDépartement de Cardiologie, CHRU de Nancy, 54500 Vandœuvre lès-Nancy, FranceDépartement de Cardiologie, CHRU de Nancy, 54500 Vandœuvre lès-Nancy, FranceCardiology Department, Wellington Hospital, Wellington 6021, New ZealandDépartement de Cardiologie, CHRU de Nancy, 54500 Vandœuvre lès-Nancy, FranceLaboratoire d’hémostase, CHRU de Nancy, 54500 Vandœuvre lès-Nancy, FranceDépartement de Cardiologie, CHRU de Nancy, 54500 Vandœuvre lès-Nancy, FranceDépartement de Cardiologie, CHRU de Nancy, 54500 Vandœuvre lès-Nancy, FranceBackground: Activated Clotting Time (ACT) guided heparinization is the gold standard for titrating unfractionated heparin (UFH) administration during atrial fibrillation (AF) ablation procedures. The current ACT target (300 s) is based on studies in patients receiving a vitamin K antagonist (VKA). Several studies have shown that in patients receiving Direct Oral Anticoagulants (DOACs), the correlation between ACT values and UFH delivered dose is weak. Objective: To assess the relationship between ACT and real heparin anticoagulant effect measured by anti-Xa activity in patients receiving different anticoagulant treatments. Methods: Patients referred for AF catheter ablation in our centre were prospectively included depending on their anticoagulant type. Results: 113 patients were included, receiving rivaroxaban (<i>n</i> = 30), apixaban (<i>n</i> = 30), dabigatran (<i>n</i> = 30), and VKA (<i>n</i> = 23). To meet target ACT, a higher UFH dose was required in DOAC than VKA patients (14,077.8 IU vs. 9565.2 IU, <i>p</i> < 0.001), leading to a longer time to achieve target ACT (46.5 min vs. 27.3 min, <i>p</i> = 0.001). The correlation of ACT and anti-Xa activity was tighter in the VKA group (Spearman correlation ρ = 0.53), compared to the DOAC group (ρ = 0.19). Despite lower ACT values in the DOAC group, this group demonstrated a higher mean anti-Xa activity compared to the VKA group (1.56 ± 0.39 vs. 1.14 ± 0.36; <i>p</i> = 0.002). Conclusion: Use of a conventional ACT threshold at 300 s during AF ablation procedures leads to a significant increase in UFH administration in patients treated with DOACs. This increase corresponds more likely to an overdosing than a real increase in UFH requirement.https://www.mdpi.com/2077-0383/10/18/4240anticoagulationatrial fibrillationheparinactivated clotting timedirect oral anticoagulantsvitamin K antagonist |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Karim Benali Julien Verain Nefissa Hammache Charles Guenancia Darren Hooks Isabelle Magnin-Poull Marie Toussaint-Hacquard Christian de Chillou Jean-Marc Sellal |
spellingShingle |
Karim Benali Julien Verain Nefissa Hammache Charles Guenancia Darren Hooks Isabelle Magnin-Poull Marie Toussaint-Hacquard Christian de Chillou Jean-Marc Sellal Running after Activated Clotting Time Values in Patients Receiving Direct Oral Anticoagulants: A Potentially Dangerous Race. Results from a Prospective Study in Atrial Fibrillation Catheter Ablation Procedures Journal of Clinical Medicine anticoagulation atrial fibrillation heparin activated clotting time direct oral anticoagulants vitamin K antagonist |
author_facet |
Karim Benali Julien Verain Nefissa Hammache Charles Guenancia Darren Hooks Isabelle Magnin-Poull Marie Toussaint-Hacquard Christian de Chillou Jean-Marc Sellal |
author_sort |
Karim Benali |
title |
Running after Activated Clotting Time Values in Patients Receiving Direct Oral Anticoagulants: A Potentially Dangerous Race. Results from a Prospective Study in Atrial Fibrillation Catheter Ablation Procedures |
title_short |
Running after Activated Clotting Time Values in Patients Receiving Direct Oral Anticoagulants: A Potentially Dangerous Race. Results from a Prospective Study in Atrial Fibrillation Catheter Ablation Procedures |
title_full |
Running after Activated Clotting Time Values in Patients Receiving Direct Oral Anticoagulants: A Potentially Dangerous Race. Results from a Prospective Study in Atrial Fibrillation Catheter Ablation Procedures |
title_fullStr |
Running after Activated Clotting Time Values in Patients Receiving Direct Oral Anticoagulants: A Potentially Dangerous Race. Results from a Prospective Study in Atrial Fibrillation Catheter Ablation Procedures |
title_full_unstemmed |
Running after Activated Clotting Time Values in Patients Receiving Direct Oral Anticoagulants: A Potentially Dangerous Race. Results from a Prospective Study in Atrial Fibrillation Catheter Ablation Procedures |
title_sort |
running after activated clotting time values in patients receiving direct oral anticoagulants: a potentially dangerous race. results from a prospective study in atrial fibrillation catheter ablation procedures |
publisher |
MDPI AG |
series |
Journal of Clinical Medicine |
issn |
2077-0383 |
publishDate |
2021-09-01 |
description |
Background: Activated Clotting Time (ACT) guided heparinization is the gold standard for titrating unfractionated heparin (UFH) administration during atrial fibrillation (AF) ablation procedures. The current ACT target (300 s) is based on studies in patients receiving a vitamin K antagonist (VKA). Several studies have shown that in patients receiving Direct Oral Anticoagulants (DOACs), the correlation between ACT values and UFH delivered dose is weak. Objective: To assess the relationship between ACT and real heparin anticoagulant effect measured by anti-Xa activity in patients receiving different anticoagulant treatments. Methods: Patients referred for AF catheter ablation in our centre were prospectively included depending on their anticoagulant type. Results: 113 patients were included, receiving rivaroxaban (<i>n</i> = 30), apixaban (<i>n</i> = 30), dabigatran (<i>n</i> = 30), and VKA (<i>n</i> = 23). To meet target ACT, a higher UFH dose was required in DOAC than VKA patients (14,077.8 IU vs. 9565.2 IU, <i>p</i> < 0.001), leading to a longer time to achieve target ACT (46.5 min vs. 27.3 min, <i>p</i> = 0.001). The correlation of ACT and anti-Xa activity was tighter in the VKA group (Spearman correlation ρ = 0.53), compared to the DOAC group (ρ = 0.19). Despite lower ACT values in the DOAC group, this group demonstrated a higher mean anti-Xa activity compared to the VKA group (1.56 ± 0.39 vs. 1.14 ± 0.36; <i>p</i> = 0.002). Conclusion: Use of a conventional ACT threshold at 300 s during AF ablation procedures leads to a significant increase in UFH administration in patients treated with DOACs. This increase corresponds more likely to an overdosing than a real increase in UFH requirement. |
topic |
anticoagulation atrial fibrillation heparin activated clotting time direct oral anticoagulants vitamin K antagonist |
url |
https://www.mdpi.com/2077-0383/10/18/4240 |
work_keys_str_mv |
AT karimbenali runningafteractivatedclottingtimevaluesinpatientsreceivingdirectoralanticoagulantsapotentiallydangerousraceresultsfromaprospectivestudyinatrialfibrillationcatheterablationprocedures AT julienverain runningafteractivatedclottingtimevaluesinpatientsreceivingdirectoralanticoagulantsapotentiallydangerousraceresultsfromaprospectivestudyinatrialfibrillationcatheterablationprocedures AT nefissahammache runningafteractivatedclottingtimevaluesinpatientsreceivingdirectoralanticoagulantsapotentiallydangerousraceresultsfromaprospectivestudyinatrialfibrillationcatheterablationprocedures AT charlesguenancia runningafteractivatedclottingtimevaluesinpatientsreceivingdirectoralanticoagulantsapotentiallydangerousraceresultsfromaprospectivestudyinatrialfibrillationcatheterablationprocedures AT darrenhooks runningafteractivatedclottingtimevaluesinpatientsreceivingdirectoralanticoagulantsapotentiallydangerousraceresultsfromaprospectivestudyinatrialfibrillationcatheterablationprocedures AT isabellemagninpoull runningafteractivatedclottingtimevaluesinpatientsreceivingdirectoralanticoagulantsapotentiallydangerousraceresultsfromaprospectivestudyinatrialfibrillationcatheterablationprocedures AT marietoussainthacquard runningafteractivatedclottingtimevaluesinpatientsreceivingdirectoralanticoagulantsapotentiallydangerousraceresultsfromaprospectivestudyinatrialfibrillationcatheterablationprocedures AT christiandechillou runningafteractivatedclottingtimevaluesinpatientsreceivingdirectoralanticoagulantsapotentiallydangerousraceresultsfromaprospectivestudyinatrialfibrillationcatheterablationprocedures AT jeanmarcsellal runningafteractivatedclottingtimevaluesinpatientsreceivingdirectoralanticoagulantsapotentiallydangerousraceresultsfromaprospectivestudyinatrialfibrillationcatheterablationprocedures |
_version_ |
1717366045590683648 |