Impact of International Normalized Ratio and Activated Clotting Time on Unfractionated Heparin Dosing During Ablation of Atrial Fibrillation
BACKGROUND—For ablation of atrial fibrillation, it is unclear how baseline international normalized ratio (INR) affects the dosing of unfractionated heparin (UFH). METHODS AND RESULTS—A retrospective review of 170 consecutive patients undergoing atrial fibrillation ablation with baseline activated c...
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| Veröffentlicht in: | Circulation. Arrhythmia and electrophysiology 2013-06, Vol.6 (3), p.491-496 |
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| creator | Hamam, Ismail Daoud, Emile G Zhang, Jianying Kalbfleisch, Steven J Augostini, Ralph Winner, Marshall Tsai, Shane Rhodes, Troy E Houmsse, Mahmoud Liu, Zhenguo Love, Charles J Tyler, Jaret Sachdev, Molly Weiss, Raul Hummel, John D |
| description | BACKGROUND—For ablation of atrial fibrillation, it is unclear how baseline international normalized ratio (INR) affects the dosing of unfractionated heparin (UFH).
METHODS AND RESULTS—A retrospective review of 170 consecutive patients undergoing atrial fibrillation ablation with baseline activated clotting time (ACT) and INR values was performed. Patients were grouped according to INR |
| doi_str_mv | 10.1161/CIRCEP.113.979088 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1370124473</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1370124473</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4568-7626bde57d2599cd86c5aeb456bc0250d5dc4a190b3eaf955fbcceae36648bf93</originalsourceid><addsrcrecordid>eNp9UcFO3TAQtKqiQoEP4IJ87OWBHceOfXwKj_Ik1CIE58h2HHDr2A_bAbXf0I-uQ6DHnna0OzO72gHgBKMzjBk-b7e37eamYHImGoE4_wAOsKjxiiBef3zHuBb74HNKPxBimGP2CexXhHFKCT8Af7bjTuoMwwC3PpvoZbbBSwe_hThKZ3-bHt7OPSh9D9c622eZS691IWfrH-CdHQ0MHt77IRajWTzPr8xORuvhRUgz62KKc1kr9-o_r1vnaMueS6uidUv7COwN0iVz_FYPwf3l5q69Wl1__7pt19crXVPGVw2rmOoNbfqKCqF7zjSVRpWZ0qiiqKe9riUWSBEjB0HpoLQ20hDGaq4GQQ7Bl8V3F8PTZFLuRpu0KVd4E6bUYdIgXNV1QwoVL1QdQ0rRDN0u2lHGXx1G3RxCt4RQMOmWEIrm9M1-UqPp_ynev14IdCG8BFd-nn666cXE7tFIlx__Y_wXQLqWnA</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1370124473</pqid></control><display><type>article</type><title>Impact of International Normalized Ratio and Activated Clotting Time on Unfractionated Heparin Dosing During Ablation of Atrial Fibrillation</title><source>MEDLINE</source><source>American Heart Association Journals</source><source>EZB-FREE-00999 freely available EZB journals</source><creator>Hamam, Ismail ; Daoud, Emile G ; Zhang, Jianying ; Kalbfleisch, Steven J ; Augostini, Ralph ; Winner, Marshall ; Tsai, Shane ; Rhodes, Troy E ; Houmsse, Mahmoud ; Liu, Zhenguo ; Love, Charles J ; Tyler, Jaret ; Sachdev, Molly ; Weiss, Raul ; Hummel, John D</creator><creatorcontrib>Hamam, Ismail ; Daoud, Emile G ; Zhang, Jianying ; Kalbfleisch, Steven J ; Augostini, Ralph ; Winner, Marshall ; Tsai, Shane ; Rhodes, Troy E ; Houmsse, Mahmoud ; Liu, Zhenguo ; Love, Charles J ; Tyler, Jaret ; Sachdev, Molly ; Weiss, Raul ; Hummel, John D</creatorcontrib><description>BACKGROUND—For ablation of atrial fibrillation, it is unclear how baseline international normalized ratio (INR) affects the dosing of unfractionated heparin (UFH).
METHODS AND RESULTS—A retrospective review of 170 consecutive patients undergoing atrial fibrillation ablation with baseline activated clotting time (ACT) and INR values was performed. Patients were grouped according to INR <2.0 (G<2; n=129) and INR ≥2.0 (G≥2; n=41). Clinical variables, UFH doses, and ACT values were recorded. An equation was derived to calculate the first bolus of UFH required to achieve an ACT ≥300 seconds, and this was subsequently assessed in 168 patients. For the initial 170 patients, the baseline INR (2.47±0.31 versus 1.53±0.31) and ACT (185±26 versus 153±30 seconds) were significantly greater in G≥2 (P<0.001). The amount of UFH to achieve the first ACT ≥300 seconds was significantly higher for G<2 versus G≥2 (9701±2390 versus 8268±2366 U; P=0.0001). Baseline INR, ACT, and weight were predictors of the UFH dosage to achieve an ACT ≥300 seconds. An equation derived to achieve an ACT ≥300 seconds after a single bolus of UFH met this end point in 160 of 168 patients (95%).
CONCLUSIONS—Baseline INR and ACT, in addition to weight, are the only predictors of UFH dosage needed to achieve an ACT ≥300 seconds. A derived equation predicted the UFH dosage to achieve an ACT ≥300 seconds.</description><identifier>ISSN: 1941-3149</identifier><identifier>EISSN: 1941-3084</identifier><identifier>DOI: 10.1161/CIRCEP.113.979088</identifier><identifier>PMID: 23685538</identifier><language>eng</language><publisher>United States: American Heart Association, Inc</publisher><subject>Adult ; Aged ; Atrial Fibrillation - diagnosis ; Atrial Fibrillation - drug therapy ; Atrial Fibrillation - surgery ; Blood Coagulation - drug effects ; Catheter Ablation - adverse effects ; Catheter Ablation - methods ; Cohort Studies ; Dose-Response Relationship, Drug ; Electrocardiography - methods ; Female ; Follow-Up Studies ; Heparin - administration & dosage ; Humans ; International Normalized Ratio ; Intraoperative Care - methods ; Male ; Middle Aged ; Multivariate Analysis ; Regression Analysis ; Retrospective Studies ; Risk Assessment ; Time Factors ; Treatment Outcome</subject><ispartof>Circulation. Arrhythmia and electrophysiology, 2013-06, Vol.6 (3), p.491-496</ispartof><rights>2013 American Heart Association, Inc.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4568-7626bde57d2599cd86c5aeb456bc0250d5dc4a190b3eaf955fbcceae36648bf93</citedby><cites>FETCH-LOGICAL-c4568-7626bde57d2599cd86c5aeb456bc0250d5dc4a190b3eaf955fbcceae36648bf93</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,3687,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23685538$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hamam, Ismail</creatorcontrib><creatorcontrib>Daoud, Emile G</creatorcontrib><creatorcontrib>Zhang, Jianying</creatorcontrib><creatorcontrib>Kalbfleisch, Steven J</creatorcontrib><creatorcontrib>Augostini, Ralph</creatorcontrib><creatorcontrib>Winner, Marshall</creatorcontrib><creatorcontrib>Tsai, Shane</creatorcontrib><creatorcontrib>Rhodes, Troy E</creatorcontrib><creatorcontrib>Houmsse, Mahmoud</creatorcontrib><creatorcontrib>Liu, Zhenguo</creatorcontrib><creatorcontrib>Love, Charles J</creatorcontrib><creatorcontrib>Tyler, Jaret</creatorcontrib><creatorcontrib>Sachdev, Molly</creatorcontrib><creatorcontrib>Weiss, Raul</creatorcontrib><creatorcontrib>Hummel, John D</creatorcontrib><title>Impact of International Normalized Ratio and Activated Clotting Time on Unfractionated Heparin Dosing During Ablation of Atrial Fibrillation</title><title>Circulation. Arrhythmia and electrophysiology</title><addtitle>Circ Arrhythm Electrophysiol</addtitle><description>BACKGROUND—For ablation of atrial fibrillation, it is unclear how baseline international normalized ratio (INR) affects the dosing of unfractionated heparin (UFH).
METHODS AND RESULTS—A retrospective review of 170 consecutive patients undergoing atrial fibrillation ablation with baseline activated clotting time (ACT) and INR values was performed. Patients were grouped according to INR <2.0 (G<2; n=129) and INR ≥2.0 (G≥2; n=41). Clinical variables, UFH doses, and ACT values were recorded. An equation was derived to calculate the first bolus of UFH required to achieve an ACT ≥300 seconds, and this was subsequently assessed in 168 patients. For the initial 170 patients, the baseline INR (2.47±0.31 versus 1.53±0.31) and ACT (185±26 versus 153±30 seconds) were significantly greater in G≥2 (P<0.001). The amount of UFH to achieve the first ACT ≥300 seconds was significantly higher for G<2 versus G≥2 (9701±2390 versus 8268±2366 U; P=0.0001). Baseline INR, ACT, and weight were predictors of the UFH dosage to achieve an ACT ≥300 seconds. An equation derived to achieve an ACT ≥300 seconds after a single bolus of UFH met this end point in 160 of 168 patients (95%).
CONCLUSIONS—Baseline INR and ACT, in addition to weight, are the only predictors of UFH dosage needed to achieve an ACT ≥300 seconds. A derived equation predicted the UFH dosage to achieve an ACT ≥300 seconds.</description><subject>Adult</subject><subject>Aged</subject><subject>Atrial Fibrillation - diagnosis</subject><subject>Atrial Fibrillation - drug therapy</subject><subject>Atrial Fibrillation - surgery</subject><subject>Blood Coagulation - drug effects</subject><subject>Catheter Ablation - adverse effects</subject><subject>Catheter Ablation - methods</subject><subject>Cohort Studies</subject><subject>Dose-Response Relationship, Drug</subject><subject>Electrocardiography - methods</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Heparin - administration & dosage</subject><subject>Humans</subject><subject>International Normalized Ratio</subject><subject>Intraoperative Care - methods</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Multivariate Analysis</subject><subject>Regression Analysis</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><issn>1941-3149</issn><issn>1941-3084</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9UcFO3TAQtKqiQoEP4IJ87OWBHceOfXwKj_Ik1CIE58h2HHDr2A_bAbXf0I-uQ6DHnna0OzO72gHgBKMzjBk-b7e37eamYHImGoE4_wAOsKjxiiBef3zHuBb74HNKPxBimGP2CexXhHFKCT8Af7bjTuoMwwC3PpvoZbbBSwe_hThKZ3-bHt7OPSh9D9c622eZS691IWfrH-CdHQ0MHt77IRajWTzPr8xORuvhRUgz62KKc1kr9-o_r1vnaMueS6uidUv7COwN0iVz_FYPwf3l5q69Wl1__7pt19crXVPGVw2rmOoNbfqKCqF7zjSVRpWZ0qiiqKe9riUWSBEjB0HpoLQ20hDGaq4GQQ7Bl8V3F8PTZFLuRpu0KVd4E6bUYdIgXNV1QwoVL1QdQ0rRDN0u2lHGXx1G3RxCt4RQMOmWEIrm9M1-UqPp_ynev14IdCG8BFd-nn666cXE7tFIlx__Y_wXQLqWnA</recordid><startdate>201306</startdate><enddate>201306</enddate><creator>Hamam, Ismail</creator><creator>Daoud, Emile G</creator><creator>Zhang, Jianying</creator><creator>Kalbfleisch, Steven J</creator><creator>Augostini, Ralph</creator><creator>Winner, Marshall</creator><creator>Tsai, Shane</creator><creator>Rhodes, Troy E</creator><creator>Houmsse, Mahmoud</creator><creator>Liu, Zhenguo</creator><creator>Love, Charles J</creator><creator>Tyler, Jaret</creator><creator>Sachdev, Molly</creator><creator>Weiss, Raul</creator><creator>Hummel, John D</creator><general>American Heart Association, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201306</creationdate><title>Impact of International Normalized Ratio and Activated Clotting Time on Unfractionated Heparin Dosing During Ablation of Atrial Fibrillation</title><author>Hamam, Ismail ; Daoud, Emile G ; Zhang, Jianying ; Kalbfleisch, Steven J ; Augostini, Ralph ; Winner, Marshall ; Tsai, Shane ; Rhodes, Troy E ; Houmsse, Mahmoud ; Liu, Zhenguo ; Love, Charles J ; Tyler, Jaret ; Sachdev, Molly ; Weiss, Raul ; Hummel, John D</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4568-7626bde57d2599cd86c5aeb456bc0250d5dc4a190b3eaf955fbcceae36648bf93</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Atrial Fibrillation - diagnosis</topic><topic>Atrial Fibrillation - drug therapy</topic><topic>Atrial Fibrillation - surgery</topic><topic>Blood Coagulation - drug effects</topic><topic>Catheter Ablation - adverse effects</topic><topic>Catheter Ablation - methods</topic><topic>Cohort Studies</topic><topic>Dose-Response Relationship, Drug</topic><topic>Electrocardiography - methods</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Heparin - administration & dosage</topic><topic>Humans</topic><topic>International Normalized Ratio</topic><topic>Intraoperative Care - methods</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Multivariate Analysis</topic><topic>Regression Analysis</topic><topic>Retrospective Studies</topic><topic>Risk Assessment</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Hamam, Ismail</creatorcontrib><creatorcontrib>Daoud, Emile G</creatorcontrib><creatorcontrib>Zhang, Jianying</creatorcontrib><creatorcontrib>Kalbfleisch, Steven J</creatorcontrib><creatorcontrib>Augostini, Ralph</creatorcontrib><creatorcontrib>Winner, Marshall</creatorcontrib><creatorcontrib>Tsai, Shane</creatorcontrib><creatorcontrib>Rhodes, Troy E</creatorcontrib><creatorcontrib>Houmsse, Mahmoud</creatorcontrib><creatorcontrib>Liu, Zhenguo</creatorcontrib><creatorcontrib>Love, Charles J</creatorcontrib><creatorcontrib>Tyler, Jaret</creatorcontrib><creatorcontrib>Sachdev, Molly</creatorcontrib><creatorcontrib>Weiss, Raul</creatorcontrib><creatorcontrib>Hummel, John D</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Circulation. Arrhythmia and electrophysiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Hamam, Ismail</au><au>Daoud, Emile G</au><au>Zhang, Jianying</au><au>Kalbfleisch, Steven J</au><au>Augostini, Ralph</au><au>Winner, Marshall</au><au>Tsai, Shane</au><au>Rhodes, Troy E</au><au>Houmsse, Mahmoud</au><au>Liu, Zhenguo</au><au>Love, Charles J</au><au>Tyler, Jaret</au><au>Sachdev, Molly</au><au>Weiss, Raul</au><au>Hummel, John D</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Impact of International Normalized Ratio and Activated Clotting Time on Unfractionated Heparin Dosing During Ablation of Atrial Fibrillation</atitle><jtitle>Circulation. Arrhythmia and electrophysiology</jtitle><addtitle>Circ Arrhythm Electrophysiol</addtitle><date>2013-06</date><risdate>2013</risdate><volume>6</volume><issue>3</issue><spage>491</spage><epage>496</epage><pages>491-496</pages><issn>1941-3149</issn><eissn>1941-3084</eissn><abstract>BACKGROUND—For ablation of atrial fibrillation, it is unclear how baseline international normalized ratio (INR) affects the dosing of unfractionated heparin (UFH).
METHODS AND RESULTS—A retrospective review of 170 consecutive patients undergoing atrial fibrillation ablation with baseline activated clotting time (ACT) and INR values was performed. Patients were grouped according to INR <2.0 (G<2; n=129) and INR ≥2.0 (G≥2; n=41). Clinical variables, UFH doses, and ACT values were recorded. An equation was derived to calculate the first bolus of UFH required to achieve an ACT ≥300 seconds, and this was subsequently assessed in 168 patients. For the initial 170 patients, the baseline INR (2.47±0.31 versus 1.53±0.31) and ACT (185±26 versus 153±30 seconds) were significantly greater in G≥2 (P<0.001). The amount of UFH to achieve the first ACT ≥300 seconds was significantly higher for G<2 versus G≥2 (9701±2390 versus 8268±2366 U; P=0.0001). Baseline INR, ACT, and weight were predictors of the UFH dosage to achieve an ACT ≥300 seconds. An equation derived to achieve an ACT ≥300 seconds after a single bolus of UFH met this end point in 160 of 168 patients (95%).
CONCLUSIONS—Baseline INR and ACT, in addition to weight, are the only predictors of UFH dosage needed to achieve an ACT ≥300 seconds. A derived equation predicted the UFH dosage to achieve an ACT ≥300 seconds.</abstract><cop>United States</cop><pub>American Heart Association, Inc</pub><pmid>23685538</pmid><doi>10.1161/CIRCEP.113.979088</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1941-3149 |
| ispartof | Circulation. Arrhythmia and electrophysiology, 2013-06, Vol.6 (3), p.491-496 |
| issn | 1941-3149 1941-3084 |
| language | eng |
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| source | MEDLINE; American Heart Association Journals; EZB-FREE-00999 freely available EZB journals |
| subjects | Adult Aged Atrial Fibrillation - diagnosis Atrial Fibrillation - drug therapy Atrial Fibrillation - surgery Blood Coagulation - drug effects Catheter Ablation - adverse effects Catheter Ablation - methods Cohort Studies Dose-Response Relationship, Drug Electrocardiography - methods Female Follow-Up Studies Heparin - administration & dosage Humans International Normalized Ratio Intraoperative Care - methods Male Middle Aged Multivariate Analysis Regression Analysis Retrospective Studies Risk Assessment Time Factors Treatment Outcome |
| title | Impact of International Normalized Ratio and Activated Clotting Time on Unfractionated Heparin Dosing During Ablation of Atrial Fibrillation |
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