Johns Hopkins Medical Institutions, Baltimore, MD, USA.
University of Hamburg, Hamburg, Germany.
Europace. 2019 Jun 1;21(6):879-885. doi: 10.1093/europace/euz057.
To describe heparin dosing requirements in patients who underwent catheter ablation of atrial fibrillation with uninterrupted anticoagulation using dabigatran etexilate (dabigatran) or warfarin to attain therapeutic activated clotting time (ACT) in the RE-CIRCUIT® study. The RE-CIRCUIT study showed significantly fewer major bleeding events in the dabigatran vs. warfarin treatment group. Unfractionated heparin was administered during the procedure to maintain ACT >300 s.
Patients were randomly assigned to dabigatran 150 mg bid or international normalized ratio-adjusted warfarin. Ablation was performed with uninterrupted anticoagulation and continued for 8 weeks after the procedure. Heparin was administered after placement of femoral sheaths before or immediately after transseptal puncture. Ablation was performed in 635 patients (dabigatran, 317; warfarin, 318); data were available from 396 patients administered heparin (dabigatran, 191; warfarin, 205). Most frequent time window from last dose of study drug to septal puncture was 0 to <4 h in the dabigatran (41.3%) and 16 to <24 h in the warfarin arms (44.7%). Overall mean (standard deviation) heparin dose was similar between the dabigatran and warfarin groups [12 402 (10 721) vs. 11 910 (8359) IU, respectively]. Heparin dosing requirement to reach therapeutic ACT was lowest when time from last dose of dabigatran to septal puncture was 0 to <4 h.
Patients treated with dabigatran required a similar amount of unfractionated heparin as those treated with warfarin to achieve an ACT of >300 s during ablation. More heparin units were required when the time from the last dose of dabigatran to septal puncture increased.
描述在行导管消融心房颤动的患者中，使用达比加群酯（达比加群）或华法林进行不间断抗凝以达到治疗性激活凝血时间（ACT）的肝素给药需求。RE-CIRCUIT 研究表明，达比加群治疗组的大出血事件显著少于华法林治疗组。在手术过程中给予未分级肝素以维持 ACT＞300s。
患者被随机分配至达比加群 150mg bid 或国际标准化比值调整的华法林治疗组。进行不间断抗凝消融，并在手术后持续 8 周。在股鞘放置后或经皮穿刺后立即给予肝素。635 例患者（达比加群 317 例；华法林 318 例）进行消融；396 例患者（达比加群 191 例；华法林 205 例）接受肝素治疗。达比加群组中最后一次研究药物剂量到经皮穿刺的最常见时间窗口为 0 至＜4h（41.3%），而华法林组为 16 至＜24h（44.7%）。达比加群和华法林组的平均（标准差）肝素剂量相似[分别为 12402（10721）IU 和 11910（8359）IU]。当达比加群最后一次给药到经皮穿刺的时间为 0 至＜4h 时，达到治疗性 ACT 的肝素给药需求最低。
在消融过程中，接受达比加群治疗的患者需要与接受华法林治疗的患者相似量的未分级肝素，以达到 ACT＞300s。当达比加群最后一次给药到经皮穿刺的时间增加时，需要更多的肝素单位。
