MEDLINE Journals

    Effect of therapeutic INR on activated clotting times, heparin dosage, and bleeding risk during ablation of atrial fibrillation.

    Authors
    Gautam S, John RM, Stevenson WG, et al. 
    Institution

    Division of Cardiovascular Medicine, Brigham and Women's Hospital, 45 Francis St., Boston, MA 02115, USA.

    Source
    J Cardiovasc Electrophysiol 2011 Mar; 22(3) :248-54.
    Abstract

    Ablation of atrial fibrillation (AF) with international normalized ratio (INR) ≥ 2.0 is safe and may reduce thromboembolic complications. Heparin is administered during the procedure, but the effect of elevated INR on heparin requirements and target activation clotting times (ACT) ≥ 350 seconds during ablation is unknown.To study the effect of INR on intraprocedural anticoagulation during ablation of AF.We retrospectively studied 427 consecutive patients over an 18-month period when we were transitioning to continuation of warfarin for AF ablation. Baseline INR, procedural ACT measurements, heparin doses and major complications were analyzed according to Group 1 with INR < 2.0 (n = 246) and Group 2 with INR ≥ 2.0 (n = 181).In Group 1, the mean INR was lower (1.3 ± 0.3 s vs 2.4 ± 0.3; P < 0.001), and the mean heparin dose was greater (106.82 ± 40.01 vs 77.03 ± 18.5 U/kg; P < 0.001). A single heparin bolus achieved ACT ≥ 350 seconds throughout the procedure in 51 patients (20.7%) in Group 1 compared to 108 patients (59.7%) in Group 2 (P < 0.01). Mean ACT values were higher in Group 2. Symptomatic pericardial effusions were similar (2.4% in Group 1 and 2.2% in Group 2). There were 3 thromboembolic cerebrovascular events in Group 1 and none in Group 2. Femoral hematomas occurred more frequently in Group 1 (8.1%) than in Group 2 (3.3%) (P = 0.007).AF ablation with INR ≥ 2.0 provides a consistent anticoagulant milieu during the procedure, with lower heparin requirements that are important to anticipate.

    Mesh
    Adult
    Aged
    Anticoagulants
    Atrial Fibrillation
    Blood Coagulation
    Boston
    Catheter Ablation
    Chi-Square Distribution
    Drug Administration Schedule
    Drug Monitoring
    Female
    Hemorrhage
    Heparin
    Humans
    International Normalized Ratio
    Male
    Middle Aged
    Predictive Value of Tests
    Regression Analysis
    Retrospective Studies
    Risk Assessment
    Risk Factors
    Time Factors
    Treatment Outcome
    Warfarin
    Language

    eng

    Pub Type(s)
    Journal Article
    PubMed ID

    20812929

    Content Manager
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