Impact of International Normalized Ratio and Activated Clotting Time on Unfractionated Heparin Dosing During Ablation of Atrial Fibrillation

Ismail Hamam; Emile G Daoud; Jianying Zhang; Steven J Kalbfleisch; Ralph Augostini; Marshall Winner; Shane Tsai; Troy E Rhodes; Mahmoud Houmsse; Zhenguo Liu; Charles J Love; Jaret Tyler; Molly Sachdev; Raul Weiss; John D Hummel

doi:10.1161/CIRCEP.113.979088

$Impact of International Normalized Ratio and Activated Clotting Time on Unfractionated Heparin Dosing During Ablation of Atrial Fibrillation$

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Impact of International Normalized Ratio and Activated Clotting Time on Unfractionated Heparin Dosing During Ablation of Atrial Fibrillation

Ismail Hamam, Emile G Daoud, Jianying Zhang, Steven J Kalbfleisch, Ralph Augostini, Marshall Winner, Shane Tsai, Troy E Rhodes, Mahmoud Houmsse, Zhenguo Liu, …

Circulation. Arrhythmia and electrophysiology, Vol.6(3), pp.491-496

06/2013

DOI: 10.1161/CIRCEP.113.979088

PMID: 23685538

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Abstract

ackground— 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.

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Title: Subtitle: Impact of International Normalized Ratio and Activated Clotting Time on Unfractionated Heparin Dosing During Ablation of Atrial Fibrillation
Creators: Ismail Hamam - From the Division of Cardiology, Ohio State University Wexner Medical Center (I.H., E.G.D., S.J.K., R.A., M.W., S.T., T.E.R., M.H., Z.L., C.J.L., J.T., M.S., R.W., J.D.H.) and Center for Biostatistics (J.Z.), Ohio State University, Columbus, OH
Emile G Daoud - From the Division of Cardiology, Ohio State University Wexner Medical Center (I.H., E.G.D., S.J.K., R.A., M.W., S.T., T.E.R., M.H., Z.L., C.J.L., J.T., M.S., R.W., J.D.H.) and Center for Biostatistics (J.Z.), Ohio State University, Columbus, OH
Jianying Zhang - From the Division of Cardiology, Ohio State University Wexner Medical Center (I.H., E.G.D., S.J.K., R.A., M.W., S.T., T.E.R., M.H., Z.L., C.J.L., J.T., M.S., R.W., J.D.H.) and Center for Biostatistics (J.Z.), Ohio State University, Columbus, OH
Steven J Kalbfleisch - From the Division of Cardiology, Ohio State University Wexner Medical Center (I.H., E.G.D., S.J.K., R.A., M.W., S.T., T.E.R., M.H., Z.L., C.J.L., J.T., M.S., R.W., J.D.H.) and Center for Biostatistics (J.Z.), Ohio State University, Columbus, OH
Ralph Augostini - From the Division of Cardiology, Ohio State University Wexner Medical Center (I.H., E.G.D., S.J.K., R.A., M.W., S.T., T.E.R., M.H., Z.L., C.J.L., J.T., M.S., R.W., J.D.H.) and Center for Biostatistics (J.Z.), Ohio State University, Columbus, OH
Marshall Winner - From the Division of Cardiology, Ohio State University Wexner Medical Center (I.H., E.G.D., S.J.K., R.A., M.W., S.T., T.E.R., M.H., Z.L., C.J.L., J.T., M.S., R.W., J.D.H.) and Center for Biostatistics (J.Z.), Ohio State University, Columbus, OH
Shane Tsai - From the Division of Cardiology, Ohio State University Wexner Medical Center (I.H., E.G.D., S.J.K., R.A., M.W., S.T., T.E.R., M.H., Z.L., C.J.L., J.T., M.S., R.W., J.D.H.) and Center for Biostatistics (J.Z.), Ohio State University, Columbus, OH
Troy E Rhodes - From the Division of Cardiology, Ohio State University Wexner Medical Center (I.H., E.G.D., S.J.K., R.A., M.W., S.T., T.E.R., M.H., Z.L., C.J.L., J.T., M.S., R.W., J.D.H.) and Center for Biostatistics (J.Z.), Ohio State University, Columbus, OH
Mahmoud Houmsse - From the Division of Cardiology, Ohio State University Wexner Medical Center (I.H., E.G.D., S.J.K., R.A., M.W., S.T., T.E.R., M.H., Z.L., C.J.L., J.T., M.S., R.W., J.D.H.) and Center for Biostatistics (J.Z.), Ohio State University, Columbus, OH
Zhenguo Liu - From the Division of Cardiology, Ohio State University Wexner Medical Center (I.H., E.G.D., S.J.K., R.A., M.W., S.T., T.E.R., M.H., Z.L., C.J.L., J.T., M.S., R.W., J.D.H.) and Center for Biostatistics (J.Z.), Ohio State University, Columbus, OH
Charles J Love - From the Division of Cardiology, Ohio State University Wexner Medical Center (I.H., E.G.D., S.J.K., R.A., M.W., S.T., T.E.R., M.H., Z.L., C.J.L., J.T., M.S., R.W., J.D.H.) and Center for Biostatistics (J.Z.), Ohio State University, Columbus, OH
Jaret Tyler - From the Division of Cardiology, Ohio State University Wexner Medical Center (I.H., E.G.D., S.J.K., R.A., M.W., S.T., T.E.R., M.H., Z.L., C.J.L., J.T., M.S., R.W., J.D.H.) and Center for Biostatistics (J.Z.), Ohio State University, Columbus, OH
Molly Sachdev - From the Division of Cardiology, Ohio State University Wexner Medical Center (I.H., E.G.D., S.J.K., R.A., M.W., S.T., T.E.R., M.H., Z.L., C.J.L., J.T., M.S., R.W., J.D.H.) and Center for Biostatistics (J.Z.), Ohio State University, Columbus, OH
Raul Weiss - From the Division of Cardiology, Ohio State University Wexner Medical Center (I.H., E.G.D., S.J.K., R.A., M.W., S.T., T.E.R., M.H., Z.L., C.J.L., J.T., M.S., R.W., J.D.H.) and Center for Biostatistics (J.Z.), Ohio State University, Columbus, OH
John D Hummel - From the Division of Cardiology, Ohio State University Wexner Medical Center (I.H., E.G.D., S.J.K., R.A., M.W., S.T., T.E.R., M.H., Z.L., C.J.L., J.T., M.S., R.W., J.D.H.) and Center for Biostatistics (J.Z.), Ohio State University, Columbus, OH
Resource Type: Journal article
Publication Details: Circulation. Arrhythmia and electrophysiology, Vol.6(3), pp.491-496
DOI: 10.1161/CIRCEP.113.979088
PMID: 23685538
NLM abbreviation: Circ Arrhythm Electrophysiol
ISSN: 1941-3149
eISSN: 1941-3084
Language: English
Date published: 06/2013
Academic Unit: Cardiovascular Medicine; Internal Medicine
Record Identifier: 9984094568302771

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