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Background: An activated clotting time (ACT) >300 seconds is the goal when anticoagulating patients with heparin during transseptal atrial fibrillation (AF) ablation procedures. Heparin dose requirements for patients who discontinue a novel oral anticoagulant (NOAC) days before ablation remain uncertain.
Methods: This retrospective analysis evaluated heparin dose requirements to achieve an ACT >300 seconds during AF ablation in 92 consecutive patients in those taking uninterrupted warfarin (n=56), those taking an interrupted NOAC (n=22), and those not taking anticoagulants (n=14).
Results: After initial weight-based heparin loading bolus, mean additional boluses to achieve an ACT >300 seconds was 1,700 units (SE 520) for the warfarin group (P<.001), 13,100 units (SE 840) for the NOAC group (P<.001), and 12,300 units (SE 1000) for the no anticoagulant group (P<.001). The mean difference in total heparin between warfarin, NOAC and no anticoagulant groups was -11,100 units (P<.001). There was no difference in total heparin amounts between the NOAC and no anticoagulant groups (P=.62).
Conclusions: Patients who discontinue a NOAC, or take no anticoagulant, before AF ablations require significantly more heparin bolus than those taking uninterrupted warfarin. Significantly more heparin was required to achieve target ACT among all 3 groups versus the weight-based heparin nomogram of 60 units/kg.
Poster Hall, Hall C
Friday, March 17, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Arrhythmias and Clinical EP: AF Ablation
Abstract Category: 6. Arrhythmias and Clinical EP: Other
Presentation Number: 1150-089
- 2017 American College of Cardiology Foundation