Uninterrupted DOACs Approach for Catheter Ablation of Atrial Fibrillation: Do DOACs Levels Matter?

Frontiers in Cardiovascular Medicine

article

Michael Hardy¹  Jonathan Douxfils³  Anne-Sophie Dincq²  Anne-Laure Sennesael⁵  Olivier Xhaet⁶  Francois Mullier¹  Sarah Lessire² 

[1] Université catholique de Louvain, Hematology Laboratory, Namur Thrombosis and Hemostasis Center, Namur Research Institute for Life Sciences, Centre Hospitalier Universitaire UCL Namur;Université catholique de Louvain, Department of Anesthesiology, Namur Thrombosis and Hemostasis Center, Namur Research Institute for Life Sciences, Centre Hospitalier Universitaire UCL Namur;Department of Pharmacy, Namur Thrombosis and Hemostasis Center, Namur Research Institute for LIfe Sciences, University of Namur;QUALIblood s.a.;Université catholique de Louvain, Pharmacy Department, Namur Thrombosis and Hemostasis Center, Namur Research Institute for Life Sciences, Centre Hospitalier Universitaire UCL Namur;Université catholique de Louvain, Department of Cardiology, Namur Thrombosis and Hemostasis Center, Centre Hospitalier Universitaire UCL Namur

关键词: atrial fibrillation;    catheter ablation;    direct oral anticoagulant;    unfractionated heparin;    activated clotting time;   

DOI  :  10.3389/fcvm.2022.864899

学科分类：地球科学(综合)

来源: Frontiers

【 摘 要 】

Most patients present for catheter ablation of atrial fibrillation (CAAF) with residual or full effect of vitamin K antagonists (VKAs) or direct oral anticoagulants (DOACs). In daily practice, it has been observed that the activated clotting time (ACT) was actually poorly sensitive to the effect of DOACs and that patients on DOACs required more unfractionated heparin (UFH) to achieve the ACT target of 300 s during the procedure, leading some authors to worry about potential overdosing. Conversely, we hypothesize that these higher doses of UFH are necessary to achieve adequate hemostasis during CAAF regardless of the residual effect of DOACs. During CAAF, thrombosis is promoted mainly by the presence of thrombogenic sheaths and catheters in the bloodstream. Preclinical data suggest that only high doses of DOACs are able to mitigate catheter-induced thrombin generation, whereas low dose UFH already do so. In addition, the effect of UFH seems to be lower in patients on DOACs, compared to patients on VKAs, explaining part of the differences observed in heparin requirements. Clinical studies could not identify increased bleeding risk in patients on DOACs compared to those on VKAs despite similar efficacy during CAAF procedures. Moreover, targeting a lower ACT was associated with an increased periprocedural thrombotic risk for both DOAC and VKA patients. Therefore, the low sensitivity of the ACT to the residual effect of DOACs should not be a major concern in its use in the interventional cardiology laboratory.

【 授权许可】

CC BY