Background: The RE-CIRCUIT study showed significantly fewer International Society on Thrombosis and Haemostasis major bleeding events (ISTH MBEs) in patients undergoing AF catheter ablation with uninterrupted dabigatran etexilate (DE) vs warfarin (W). Heparin was administered during the procedure to maintain activated clotting time (ACT) >300 s, as recommended by current clinical guidelines. Here we describe the heparin dose administered on the day of ablation and regional differences.
Methods: Patients were randomly assigned to DE 150 mg twice daily (bid) or international normalized ratio-adjusted W. Ablation was performed with uninterrupted anticoagulation and continued for 8 weeks after the procedure. Heparin was administered after the placement of femoral sheaths before or immediately after a transseptal puncture.
Results: Ablation was performed in 635 patients (DE, 317; W, 318); data were available from 396 patients administered heparin (DE, 191; W, 205). The most usual time window from the last dose of study drug to septal puncture was 0-<4 h in the DE (41.3%) and 16-<24 h in the W arms (44.7%). The overall heparin dose was similar between the DE and W groups (12,402 [10,721] vs 11,910  IU, respectively). In patients who had an ISTH MBE, the dose was 17,100 (12,935) and 10,000 (6087) IU, in 4 and 13 patients; for those with no ISTH MBE, the dose was 12,301 (10,667) and 12,027 (8490) IU, in 187 DE and 192 W patients, respectively. The mean total heparin dose was greater in North America and lower in Eastern Europe. Mean ACT was 312 and 308 s in the DE and W groups, respectively. The ACT was higher in the DE group the closer it was measured to the time from last dose. The table shows heparin use according to ACT categories.
Conclusions: Patients treated with DE 150 mg bid required a similar amount of unfractionated heparin as those treated with W. Furthermore, there was a trend towards a need for more heparin units with the increase in the time from the last dose to septal puncture.