Differences in activated clotting time among uninterrupted anticoagulants during the periprocedural period of atrial fibrillation ablation

Background Close monitoring of intraoperative activated clotting time (ACT) is crucial to prevent complications during the periprocedural period of atrial fibrillation (AF) ablation. However, little is known about the ACT in patients receiving new oral anticoagulant agents (NOACs). Objective The purpose of this study was to evaluate change in the ACT among anticoagulant agents used during the periprocedural period of AF ablation. Methods We examined 869 consecutive patients who underwent AF ablation-between April 2012 and August 2014 and received NOACs (n = 499), including dabigatran, rivaroxaban, and apixaban, or warfarin (n = 370) for uninterrupted periprocedural anticoagulation. Changes in intraprocedural ACT were investigated among the anticoagulant agents. Furthermore, the incidence of periprocedural events was estimated. Results The average time in minutes required for achieving a target ACT >300 seconds was significantly longer in the dabigatran group (DG) and apixaban group (AG) than in the warfarin group (WG) and rivaroxaban group (RG) (60 and 70 minutes vs 8 and 9 minutes, respectively; P <.001). In addition, the proportion of patients who achieved the target ACT after initial heparin bolus was significantly lower in the DG and AG than in the WG and RG (36% and 26% vs 84% and 78%, respectively; P <.001). Furthermore, the incidence of periprocedural complications was equivalent among the groups. Conclusion The average time required to reach the target ACT was longer in the DG and AG than in the WG and RG.