Muller Marie, Godet Julien, Delabranche Xavier, Sattler Laurent, Millard David, Marzak Halim, Mertes Paul Michel, Steib Annick, Grunebaum Lelia, Jesel Laurence, Tacquard Charles Ambroise
Department of Anesthesia and Intensive Care, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France.
Groupe Méthodes en Recherche Clinique (GMRC), Hôpitaux Universitaires de Strasbourg, Hôpital Civil, 67000 Strasbourg, France.
J Clin Med. 2023 Mar 14;12(6):2236. doi: 10.3390/jcm12062236.
Unfractionated heparin (UFH) is used as an anticoagulant during the atrial fibrillation (AF) ablation procedure to prevent the occurrence of thromboembolic events. Guidelines recommend an activated clotting time (ACT) greater than 300 s (s) based on studies of patients treated with vitamin K antagonist (VKA) for their AF. However, direct oral anticoagulants (DOACs) have supplanted VKAs in AF and are now used as first-line therapy. It is recommended not to interrupt them during the procedure, which could interfere with the ACT measures.
To assess the real-life relationship between ACT, DOAC concentrations, and UFH anti-Xa activity in patients treated by uninterrupted DOAC therapy.
We conducted a single-center retrospective study. We analyzed consecutive patients with AF who underwent catheter ablation under DOAC therapy.
In total, 40 patients were included, including 15 (37.5%), 20 (50.0%), and 5 (12.5%) on rivaroxaban, apixaban, and dabigatran, respectively. Baseline ACT was significantly lower in the apixaban group. ACT was linearly correlated with the residual concentration of apixaban and dabigatran but not with rivaroxaban. After UFH injection, ACT was linearly correlated with the anti-Xa activity, regardless of DOAC. Patients in the apixaban group received a higher total dose of UFH during the procedure to achieve a target ACT > 300 s, which resulted in significantly higher anti-Xa activity during the procedure.
Our results raise the question of optimal management of intra-procedural heparin therapy and highlight the limitations of the ACT test, particularly in patients on apixaban.
在心房颤动（AF）消融手术期间，普通肝素（UFH）用作抗凝剂以预防血栓栓塞事件的发生。基于对接受维生素K拮抗剂（VKA）治疗AF患者的研究，指南推荐活化凝血时间（ACT）大于300秒（s）。然而，直接口服抗凝剂（DOAC）已在AF治疗中取代了VKA，现被用作一线治疗药物。建议在手术过程中不要中断使用DOAC，因为这可能会干扰ACT测量。
评估在接受不间断DOAC治疗的患者中，ACT、DOAC浓度和UFH抗Xa活性之间的实际关系。
我们进行了一项单中心回顾性研究。我们分析了在DOAC治疗下接受导管消融的连续性AF患者。
总共纳入了40例患者，其中分别有15例（37.5%）、20例（50.0%）和5例（12.5%）正在服用利伐沙班、阿哌沙班和达比加群。阿哌沙班组的基线ACT显著更低。ACT与阿哌沙班和达比加群的残余浓度呈线性相关，但与利伐沙班无关。注射UFH后，无论使用何种DOAC，ACT均与抗Xa活性呈线性相关。为了使ACT>300 s，阿哌沙班组患者在手术过程中接受了更高的UFH总剂量，这导致手术过程中的抗Xa活性显著更高。
我们的结果提出了手术过程中肝素治疗的最佳管理问题，并突出了ACT检测的局限性，尤其是在服用阿哌沙班的患者中。
