Evidence map›Paper›PMID 29532536›Full record

ArticleClinical cardiology2018

Periprocedural management of anticoagulation for atrial fibrillation catheter ablation in direct oral anticoagulant-treated patients.

Anne-Céline Martin, Sarah Lessire, Isabelle Leblanc, Anne-Sophie Dincq, Ivan Philip, Isabelle Gouin-Thibault, Anne Godier

Open access · bronzeAbstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Clinical cardiology, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
0.3field-weighted citation impact, top 37% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 5 citations in OpenAlex.

  1. Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors at 3 institutions in 2 countries.

Anne-Céline MartinService de Cardiologie, Service de Santé des Armées, Hôpital d'Instruction des Armées Percy, Clamart, France.ORCID http://orcid.org/0000-0002-6148-3523
Sarah LessireNamur Thrombosis and Haemostasis Center, Department of Anesthesiology, Université Catholique de Louvain, Namur, Belgium.
Isabelle LeblancService d'Anesthésie, Institut Mutualiste Montsouris, Paris, France.
Anne-Sophie DincqNamur Thrombosis and Haemostasis Center, Department of Anesthesiology, Université Catholique de Louvain, Namur, Belgium.
Ivan PhilipService d'Anesthésie, Institut Mutualiste Montsouris, Paris, France.
Isabelle Gouin-ThibaultFaculté de Pharmacie, Inserm UMRS_1140, Université Paris Descartes, Paris, France.
Anne GodierFaculté de Pharmacie, Inserm UMRS_1140, Université Paris Descartes, Paris, France.
Délégation Paris 5 · FRInstitute Mutualiste Montsouris · FRUniversity of Namur · BE

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundGuidelines recommend performing atrial fibrillation (AF) catheter ablation without interruption of a direct oral anticoagulants (DOACs) and to administer unfractionated heparin (UFH) for an activated clotting time (ACT) ≥300 seconds, by analogy with vitamin K antagonist (VKA). Nevertheless, pharmacological differences between DOACs and VKA, especially regarding ACT sensitivity and UFH response, prevent extrapolation from VKA to DOACs. HYPOTHESIS: The level of anticoagulation at the time of the procedure in uninterrupted DOAC-treated patients is unpredictable and would complicate intraprocedural UFH administration and monitoring.

methodsThis prospective study included interrupted DOAC-treated patients requiring AF ablation. Preprocedural DOAC concentration ([DOAC]), intraprocedural UFH administration, and ACT values were recorded. A cohort of DOAC-treated patients requiring flutter catheter ablation was considered to illustrate [DOAC] without DOAC interruption.

resultsForty-eight patients underwent AF and 14 patients underwent flutter ablation, respectively. In uninterrupted DOAC-treated patients, [DOAC] ranged from ≤30 to 466 ng/mL. When DOAC were interrupted, from 54 to 218 hours, [DOAC] were minimal (maximum: 36 ng/mL), preventing DOAC-ACT interference. Anyway, ACT values were poorly correlated with UFH doses (R

conclusionsOur data showed that uninterrupted DOAC therapy resulted in an unpredictable and highly variable initial level of anticoagulation before catheter ablation. Moreover, even with DOAC interruption preventing interference between DOAC, UFH, and ACT, intraprocedural UFH monitoring was complex. Altogether, our exploratory results call into question the appropriateness of transposing UFH dose protocols, as well as the relevance of ACT monitoring in uninterrupted DOAC-treated patients.

Indexed as

Catheter AblationAdministration, OralAdultAgedAged, 80 and overAnticoagulantsAtrial FibrillationAtrial FlutterBlood CoagulationDrug Administration ScheduleDrug MonitoringFemaleFranceHeparinHumansMaleAnticoagulantsHeparinActivated Clotting TimeAtrial Fibrillation Catheter AblationDirect Oral AnticoagulantHeparinMonitoring

Identifiers

PMID29532536
PMCPMC6489798
OpenAlexW2792599025

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.