title: Influence of the concomitant use of heparin on the effects of warfarin during catheter ablation for atrial fibrillation.
abstract: Warfarin is widely used to perform catheter ablation for atrial fibrillation (AF). Heparin is usually administered during this procedure to prevent thromboembolic events, while protamine is used to reduce the incidence of bleeding complications. The purpose of this study was to investigate the influence of heparin and protamine administration on the effects of warfarin and its safety. The subjects included 226 AF patients (206 males, 54.9 ± 9.1 years, paroxysmal/persistent AF: 118/108) undergoing AF ablation with the discontinuation of warfarin administration over 2 days. Heparin was administered to achieve an activated clotting time (ACT) above 300 s during the procedure. Several parameters of the coagulation status, including the prothrombin time international normalized ratio (PT-INR) and ACT values, measured immediately before and after protamine infusion were compared. The mean value of PT-INR prior to ablation was 1.9 ± 0.6. At the end of the procedure, the mean ACT and PT-INR values were 348.0 ± 52.9 and 2.9 ± 0.7, respectively. Following the infusion of 30 mg of protamine, both the ACT and PT-INR values significantly decreased, to 159.6 ± 31.0 (p < 0.0001) and 1.6 ± 0.3 (p < 0.0001), respectively. No cases of symptomatic cerebral infarction were observed, although femoral hematomas developed in 17 (7.5 %) of the patients without further consequence. The concomitant use of heparin augments the effect of warfarin. Meanwhile, protamine administration immediately reverses both the ACT and PT-INR, indicating the applicability of protamine for AF ablation in patients under the mixed administration of heparin and warfarin.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-shinbashi, Minato-Ku, Tokyo, 105-8471, Japan. inadi@jikei.ac.jp.
authors.forename: Keiichi
authors.initials: K
authors.lastname: Inada
authors.affiliation: Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-shinbashi, Minato-Ku, Tokyo, 105-8471, Japan.
authors.forename: Seiichiro
authors.initials: S
authors.lastname: Matsuo
authors.affiliation: Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-shinbashi, Minato-Ku, Tokyo, 105-8471, Japan.
authors.forename: Ken-Ichi
authors.initials: K
authors.lastname: Tokutake
authors.affiliation: Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-shinbashi, Minato-Ku, Tokyo, 105-8471, Japan.
authors.forename: Ken-Ichi
authors.initials: K
authors.lastname: Yokoyama
authors.affiliation: Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-shinbashi, Minato-Ku, Tokyo, 105-8471, Japan.
authors.forename: Mika
authors.initials: M
authors.lastname: Hioki
authors.affiliation: Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-shinbashi, Minato-Ku, Tokyo, 105-8471, Japan.
authors.forename: Ryohsuke
authors.initials: R
authors.lastname: Narui
authors.affiliation: Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-shinbashi, Minato-Ku, Tokyo, 105-8471, Japan.
authors.forename: Keiichi
authors.initials: K
authors.lastname: Ito
authors.affiliation: Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-shinbashi, Minato-Ku, Tokyo, 105-8471, Japan.
authors.forename: Shin-Ichi
authors.initials: S
authors.lastname: Tanigawa
authors.affiliation: Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-shinbashi, Minato-Ku, Tokyo, 105-8471, Japan.
authors.forename: Seigo
authors.initials: S
authors.lastname: Yamashita
authors.affiliation: Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-shinbashi, Minato-Ku, Tokyo, 105-8471, Japan.
authors.forename: Michifumi
authors.initials: M
authors.lastname: Tokuda
authors.affiliation: Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-shinbashi, Minato-Ku, Tokyo, 105-8471, Japan.
authors.forename: Kenri
authors.initials: K
authors.lastname: Shibayama
authors.affiliation: Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-shinbashi, Minato-Ku, Tokyo, 105-8471, Japan.
authors.forename: Satoru
authors.initials: S
authors.lastname: Miyanaga
authors.affiliation: Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-shinbashi, Minato-Ku, Tokyo, 105-8471, Japan.
authors.forename: Ken-Ichi
authors.initials: K
authors.lastname: Sugimoto
authors.affiliation: Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-shinbashi, Minato-Ku, Tokyo, 105-8471, Japan.
authors.forename: Michihiro
authors.initials: M
authors.lastname: Yoshimura
authors.affiliation: Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-shinbashi, Minato-Ku, Tokyo, 105-8471, Japan.
authors.forename: Teiichi
authors.initials: T
authors.lastname: Yamane
mesh_terms: D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D001281:Atrial Fibrillation / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D001777:Blood Coagulation / Q000187:drug effects*; D001780:Blood Coagulation Tests; D016063:Blood Loss, Surgical / Q000517:prevention & control; D017115:Catheter Ablation / Q000009:adverse effects; D004334:Drug Administration Schedule; D016903:Drug Monitoring / Q000379:methods; D005260:Female; D006493:Heparin / Q000008:administration & dosage* / Q000009:adverse effects; D006494:Heparin Antagonists / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000139:chemically induced / Q000517:prevention & control; D011237:Predictive Value of Tests; D011479:Protamines / Q000008:administration & dosage; D012307:Risk Factors; D013923:Thromboembolism / Q000209:etiology / Q000517:prevention & control; D013997:Time Factors; D016896:Treatment Outcome; D014859:Warfarin / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D000925:Anticoagulants; D006494:Heparin Antagonists; D011479:Protamines; D014859:Warfarin; D006493:Heparin
keywords: Anticoagulation; Atrial fibrillation; Catheter ablation; Protamine; Warfarin