Anticoagulation during percutaneous catheter ablation should be closely monitored with Activated Clotting Time (ACT). However, VKA or direct oral anticoagulant drugs (DOAC) may act differently on ACT and thus on heparin needs.
The aim of this study was to compare ACT and heparin requirements during catheter ablation under various oral anticoagulant drug regimens and in controls.
Sixty consecutive patients referred for ablation were retrospectively included: group 1 (n=15, VKA), group 2 (n=15, uninterrupted rivaroxaban), group 3 (n=15, uninterrupted apixaban) and group 4 (n=15, controls). Heparin requirements and ACT were compared throughout the procedure.
Heparin requirements during the procedure were significantly lower in patients under VKA compared to DOAC and lower in DOAC patients compared to controls.
First and averaged ACT values were significantly higher in patients under VKA compared to DOAC and similar in DOAC patients compared to controls. Furthermore, anticoagulation control as evaluated by the number/proportion of ACT>300 as well as the time passed over 300sec was significantly better in patients under VKA versus DOAC, but the differences were not significant between DOAC versus controls. Finally, the number of patients/ACT with excessive ACT values was significantly higher in VKA versus DOAC patients versus controls.
There was no significant difference between DOAC drugs for ACT or heparin dosing throughout the procedure.
VKA allowed less heparin requirement despite reaching higher ACT values and more efficient anticoagulation control (although with a higher risk for excessive values) compared to patients under long-term DOAC therapy and to controls.Le texte complet de cet article est disponible en PDF.