Key result
Minimally interrupted DOAC strategy shows no meaningful difference in pre-ablation ACT vs. uninterrupted DOACs.
Why the study?
Differences in sensitivity to ACT assays exist among DOACs, prompting investigation of pre-ablation ACT across ablation start times, safety outcomes in minimally interrupted versus uninterrupted DOAC regimens, and differences among four DOACs.
Does a minimally interrupted DOAC strategy affect pre-ablation activated clotting time or safety outcomes compared to an uninterrupted DOAC strategy in patients undergoing atrial fibrillation ablation?
RCT (n=584)
Randomly allocated
No
Does a minimally interrupted DOAC strategy affect pre-ablation activated clotting time or safety outcomes compared to an uninterrupted DOAC strategy in patients undergoing atrial fibrillation ablation?
Absolute Event Rate: 138% vs 142%
Both minimally interrupted and uninterrupted DOAC regimens provide similar periprocedural anticoagulation statuses and acceptable safety profiles for patients undergoing atrial fibrillation ablation.
Similar pre-ACT and safety with minimally interrupted versus uninterrupted DOAC in AF ablation; supports either strategy clinically and confirms consistency across agents.
BACKGROUND: Activated clotting time (ACT)-guided heparinization is used during atrial fibrillation (AF) ablation. Differences in sensitivity to ACT assays have been identified among different direct oral anticoagulants (DOACs). OBJECTIVE: We aimed to examine ACT just before ablation (pre-ACT) for different ablation start times (9:00, 11:00, 13:00, or 15:00) and ablation safety outcomes in minimally interrupted (min-Int) and uninterrupted (Unint) DOAC regimens and examine differences in pre-ACT values among four DOACs. METHODS: Consecutive patients were randomized into the min-Int (n = 307) or Unint (n = 277) groups. DOACs examined were apixaban, dabigatran, edoxaban, and rivaroxaban. RESULTS: No sequential changes in pre-ACT values were observed for each DOAC used and for all four DOACs combined in the min-Int and Unint groups. There was no meaningful difference in pre-ACT at each ablation start time between the groups. Clinically significant differences in overall pre-ACT were not obtained between the groups (138 ± 24 vs 142 ± 23 seconds). The pre-ACT (baseline) value for dabigatran was on average 29 seconds higher than that for the other three DOACs. The min-Int and Unint groups showed similar thromboembolic (0% vs 0%) and bleeding event rates (major, 1% vs 0%; all, 3.5% vs 2.5%). CONCLUSION: The pre-ACT did not show a sequential change in the min-Int and Unint groups. No notable differences in the time-dependent change in pre-ACT between the groups were observed. Variations in baseline ACT suggest the need for moderate adjustment of ACT for adequate modification of heparin dose for the other three DOACs. Both regimens provided similar acceptable AF ablation safety outcomes.
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Yamaji et al. (2019) conducted an RCT in Atrial fibrillation undergoing catheter ablation (n=584). Minimally interrupted direct oral anticoagulant (DOAC) strategy vs. Uninterrupted DOAC strategy was evaluated on Activated clotting time just before ablation (pre-ACT). In patients undergoing atrial fibrillation ablation, a minimally interrupted direct oral anticoagulant strategy did not produce clinically significant differences in pre-ablation activated clotting time compared to an uninterrupted strategy (138 vs 142 seconds).
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