Abstract
Introduction: A weight-based heparin dosing policy that adjusted for
pre-procedural oral anticoagulation was implemented to reduce the
likelihood of sub-therapeutic dosing during left atrial catheter
ablation procedures. Our hypothesis was that initiation of the protocol
would result in a greater prevalence of therapeutic Activated Clotting
Time (ACT) values and decreased time to therapeutic ACT during left
atrial ablation procedures. Methods: A departmental protocol was
initiated for which subjects received intravenous unfractionated heparin
(UFH) to achieve and maintain a goal of ACT >300 seconds.
Initial bolus dose was adjusted for pre-procedure oral anticoagulation
and weight as follows: 50 units/kg for those receiving warfarin, 75
units/kg for those not anticoagulated, and 120 units/kg for those on
direct oral anticoagulants. An UFH infusion was initiated at 10% of the
bolus per hour. An observational study was performed on 100 consecutive
left atrial ablation procedures with usual care, versus 100 with
protocol guided peri-procedural care. Results: When usual care and
protocol guided cohorts were compared, significant findings were limited
to those on pre-procedure direct oral anticoagulant (DOAC). The initial
UFH bolus increased from 97±29 units/Kg to 113±29 units/Kg
(p<0.001), the proportion of therapeutic ACT on first draw
after heparin administration increased from 58% to 77% (p=0.010), and
the time to therapeutic ACT after UFH administration decreased from
37.8±19.8 minutes to 30.2±16.4 minutes (p=0.032). Conclusion: A
weight-based protocol for peri-procedural UFH administration resulted in
a higher proportion of therapeutic ACT values and decreased the time to
therapeutic ACT for those on pre-procedure DOAC.