Introduction:

Data on optimal dosing of unfractionated heparin (UFH) in the presence of a direct oral anticoagulant (DOAC) to achieve and maintain an activated clotting time (ACT) of ≥300 seconds during catheter ablation of atrial fibrillation (CA-AF) are limited and prevalence of obesity adds to the unpredictable response to UFH.

Methods and Results:

One hundred seventeen consecutive patients undergoing CA-AF were prospectively administered weight-adjusted, weight-based UFH using a pre-specified detailed protocol and retrospectively analyzed. Due to lack of distribution of UFH into muscle or adipose tissue and lower degree of vascularity in the latter compartment, each patient’s ideal and actual weights were used to determine the adjusted-weight for use in all UFH doses. A UFH bolus of 200 units/kg was administered intravenously followed by an infusion of 35 units/kg/hour. The mean age was 65 years, and 85 patients (72.6%) were male. The average body mass index (BMI) was 30 (range 18-50) kg/m². After the initial UFH bolus dose, 99 patients (84.6%) achieved ACT ≥300 sec with a mean (± SD) of 380 ± 79 sec. The mean time to reach an ACT ≥300 in all patients was 14.6 ± 12.4 minutes. Among all measured ACT values, 423 (90.8%) were ≥300 seconds. These results were consistent within all BMI categories. There were no intraprocedural thrombotic or hemorrhagic complications. Two patients (1.7%) sustained groin vascular access site hematoma without subsequent intervention and 7 patients (6%) experienced minor oozing post-procedurally.

Conclusions:

Our comprehensive weight-adjusted, weight-based UFH protocol, during CA-AF in presence of a DOAC, rapidly achieved and maintained an effective ACT irrespective of BMI.

中文翻译：

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在直接口服抗凝剂和广谱体重指数存在下房颤导管消融期间的综合术中普通肝素方案

介绍：

在房颤导管消融 (CA-AF) 期间，在存在直接口服抗凝剂 (DOAC) 的情况下，为了实现和维持 ≥ 300 秒的活化凝血时间 (ACT) 的最佳剂量的普通肝素 (UFH) 的数据是有限的，并且肥胖的流行增加了对 UFH 的不可预测的反应。

方法和结果：

117 名连续接受 CA-AF 的患者使用预先指定的详细方案前瞻性地进行了体重调整、基于体重的 UFH，并进行了回顾性分析。由于 UFH 缺乏在肌肉或脂肪组织中的分布以及后隔室的血管分布程度较低，因此使用每位患者的理想体重和实际体重来确定用于所有 UFH 剂量的调整体重。静脉注射 200 单位/公斤的 UFH，然后以 35 单位/公斤/小时的速度输注。平均年龄为 65 岁，85 名患者（72.6%）为男性。平均体重指数（BMI）为 30（范围 18-50）kg/m ². 在初始 UFH 推注剂量后，99 名患者 (84.6%) 达到 ACT ≥300 秒，平均 (± SD) 为 380 ± 79 秒。所有患者达到 ACT ≥300 的平均时间为 14.6 ± 12.4 分钟。在所有测量的 ACT 值中，有 423 个（90.8%）≥300 秒。这些结果在所有 BMI 类别中都是一致的。没有术中血栓或出血并发症。2 名患者 (1.7%) 在没有后续干预的情况下持续腹股沟血管通路部位血肿，7 名患者 (6%) 在术后出现轻微渗血。

结论：

我们全面的体重调整、基于体重的 UFH 协议，在 CA-AF 期间，在 DOAC 存在的情况下，迅速实现并保持了有效的 ACT，而与 BMI 无关。