Evidence map›Paper›PMID 30982849›Full record

Trial reportEuropace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology2019

Heparin dosing in uninterrupted anticoagulation with dabigatran vs. warfarin in atrial fibrillation ablation: RE-CIRCUIT study.

Hugh Calkins, Stephan Willems, Atul Verma, Richard Schilling, Stefan H Hohnloser, Ken Okumura, Matias Nordaby, Eva Kleine, Branislav Bis, Edward P Gerstenfeld

Abstract readMulticenter StudyRandomized Controlled Trial
In one paragraph

Trial report in Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
10citing papers in PubMed, 1 pooled it
–field-weighted citation impact
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

10 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Article
  3. Article
  4. Observational
  5. Article
  6. 2024 European Heart Rhythm Association/Heart Rhythm Society/Asia Pacific Heart Rhythm Society/Latin American Heart Rhythm Society expert consensus statement on catheter and surgical ablation of atrial fibrillation.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2024
    Article
  7. Article
  8. Atrial fibrillation ablation: is common practice far from guidelines' world? The Italian experience from a national survey.Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing · 2022
    Article
  9. Article
  10. Article
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

10 authors.

Hugh CalkinsJohns Hopkins Medical Institutions, Baltimore, MD, USA.
Stephan WillemsUniversity of Hamburg, Hamburg, Germany.
Atul VermaUniversity of Toronto, Toronto, Ontario, Canada.
Richard SchillingSt Bartholomew's Hospital, London, UK.
Stefan H HohnloserJ.W. Goethe University, Frankfurt, Germany.
Ken OkumuraSaiseikai Kumamoto Hospital, Cardiovascular Center, Kumamoto, Japan.
Matias NordabyBoehringer Ingelheim Pharma, Ingelheim am Rhein, Germany.
Eva KleineBoehringer Ingelheim Pharma, Ingelheim am Rhein, Germany.
Branislav BisBoehringer Ingelheim RCV, Vienna, Austria.
Edward P GerstenfeldUniversity of California, San Francisco, CA, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

aimsTo 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. METHODS AND

resultsPatients 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.

conclusionPatients 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.

Indexed as

AnticoagulantsAntithrombinsAtrial FibrillationCatheter AblationDabigatranFemaleHeparinHumansInternational Normalized RatioMaleMiddle AgedProspective StudiesWarfarinAnticoagulantsAntithrombinsDabigatranHeparinWarfarinAnticoagulationAtrial fibrillationCatheter ablationDabigatranHeparin dosingWarfarin

Identifiers

PMID30982849
PMCPMC6781146

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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.