Real-life experience with a new anticoagulation regimen for patients undergoing left-sided ablation procedures
Bibliographic record
Abstract
BACKGROUND: Current guidelines for anticoagulation during left-sided procedures recommend the administration of unfractionated heparin (UFH) with an initial bolus of 50-100 U/kg, followed by continuous infusion to maintain an activated clotting time (ACT) ≥ 300 s. Our objective was to compare the effectiveness of this standard regimen (100 U/kg bolus) to a more aggressive approach (200 U/kg bolus). METHODS: We collected data on a series of consecutive patients undergoing left sided ablation procedures. Patients with an INR ≥2.0 on the day of the procedure were excluded. Procedural anticoagulation was performed using one of two UFH regimens: 1) 100 U/kg bolus, followed by 10 U/kg/hour infusion or 2) 200 U/kg bolus, followed by 20 U/kg/hour infusion. ACT was measured 10 min after the second bolus and then controlled every 20 min. Heparin was titrated throughout the procedure to maintain an ACT 300-400 s. RESULTS: 145 consecutive patients were included in the study: 34 received an initial bolus of 100 U/kg and 111 received 200 U/kg. The mean time required to reach an ACT ≥300 s was 15.25 min (95% CI 12.97-17.03) in the 200 U/kg group and 51.23 min (95% CI 40.65-61.81) in the 100 U/kg group (p < 0.001). There was no difference between groups with regard to thromboembolic or hemorrhagic complications. CONCLUSION: Current anticoagulation guidelines for left-sided ablation procedures almost universally fail to achieve an initial ACT ≥300 s. A 200 U/kg heparin bolus is much more effective to promptly reach the target ACT, with a low rate of overshoot.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.007 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".