Effects of “Minimally-Interrupted” Direct Oral Anticoagulants on the Intensity of Anticoagulation during Atrial Fibrillation Ablation

Perspective from E-journals in J-STAGE

Abstract

Periprocedural anticoagulation for atrial fibrillation ablation is a critical issue in the era of the widespread use of direct oral anticoagulants（DOAC）. Uninterrupted warfarin is now established as a standard care of periprocedural anticoagulation. However, there is still a debate with regard to the management of DOAC because of a lack of evidence or experience. “Uninterrupted DOAC”might be feasible though bleeding complications can be fatal without specific antidotes. Thus, we investigated the feasiblity of“minimally-interrupted DOAC ; MID”protocol as a periprocedural oral anticoagulation management for atrial fibrillation ablation. Under the MID protocol, DOAC was discontinued just one dose before the procedure. We investigated the effects of MID on anticoagulation during procedures by measuring given unfractionated heparin doses and time to target ACT（activated clotting time）>300seconds among a total of consecutive 135 patients undergone atrial fibrillation ablation in our institute. Time to target ACT（TTA）was significantly delayed in the rivaroxaban group（RG）and apixaban group（AG）as compared to dabigatran group（DG）, though DG was comparable to warfarin group（WG）. Required total heparin dose was significantly larger in patients of factor Xa inhibitors than those of WG or DG. Based on our results, the response to unfractionated heparin might be different in factor-Xa inhibitors as compared to dabigatran under MID protocol. Our results suggest that optimal periprocedural anticoagulation protocol should be discussed specifically for each of DOAC besides warfarin.