The Impact Of Different Anticoagulation Therapies On Heparin Dosage Applied In Atrial Fibrillation Catheter Ablation

Background: Anticoagulant therapy is an important part of atrial fibrillation treatment.In order to avoid thrombus formation,heparin is required during atrial fibrillation ablation.With the continuous promotion of Non-Vitamin K Antagonist Oral Anticoagulants,different anticoagulation therapies before ablation may lead to different anticoagulant intensity.At present,domestic and foreign researches mainly focus on the effectiveness and safety evaluation of new anticoagulant anticoagulants,there is no corresponding suggestion for the dosage of heparin applied in ablation.Objectives: Differences in the ACT during ablation and adequate heparin dosing in receiving different anticoagulation therapy were examined to estimate whether the heparin dosing during ablation is suitable for different anticoagulation therapies.Methods: 346 Patients who received warfarin,low-molecular-weight heparin,dabigatran etexilate and rivaroxaban were studied.All of them underwent their first AF ablation and decreased hepatic and renal function were excluded.100U/kg of an initial bolus heparin in dose was used in the each group.additional heparin dosage administered according to the ACT which was measured in 15 min intervals and to maintain the ACT within 230-350 s until the end of ablation.We analyzed patient characteristics,ACT and complications.Results: No significant differences were found in the patients’ background characteristics,such as age,sex and associated disorders.The baseline ACTs in the warfarin(128.1±28.8s,P=0.033)and dabigatran(132.9±36.0s,P=0.021)groups were significantly longer than those in the rivaroxaban(112.8±22.2s)group.The 15min-ACTin the warfarin(258.6±56.3s)was longer then dabigatran(242.8±42.9s,P=0.033).Compare with low-molecular-weight heparin(224.3±40.4s,28.0%)and rivaroxaban(226.3±32.4s,22.9%)groups,The 15min-ACTs and initial-standard-reaching rates in the warfarin(258.6±56.3s,53.0%)and dabigatran(242.8±42.9s,44.9%)groups were significantly longer(P<0.001)and higher(P<0.001).The 1h-ACT in the warfarin(254.5±48.6s)group were significantly longer than another three groups(dabigatran233.2±33.2s,P=0.002;low-molecular-weight heparin 226.4±34.0s,P<0.001;rivaroxaban230.9±29.6s,P=0.005).The 1h-standard-reaching rate in the warfarin(66.0%)group were significantly higher than that in the dabigatran(40.9%,P=0.015)and rivaroxaban(27.3%,P=0.039)groups.The total heparin required in rivaroxaban(117.5±16.4u/kg)group were significantly higher than that in the dabigatran(106.0±7.0u/kg,P<0.001)and warfarin(107.6±10.1u/kg,P=0.002)groups.During the perioperative period,no patients who received any of the four different groups exhibited any thromboembolic complications,and only a few bleeding episodes was observed which has no different between the four groups(P=0.388).Late thromboembolic and bleeding complications were not observed in any of the patients during a follow-up period of at least 30 days after AF ablation.Conclusions: The ACT and standard-reaching rate of ACT in the patients under dabigatran etexilate,low-molecular-weight heparin and rivaroxaban anticoagulation therapy before ablation was lower then warfarin.For those patients,increasing dosage of heparin is required to achieve the satisfactory anticoagulant intensity.But,the specific heparin dosage need to be further studied.