Effect of uninterrupted dabigatran or rivaroxaban on achieving ideal activated clotting time to heparin response during catheter ablation in patients with atrial fibrillation

BACKGROUND Uninterrupted use of oral anticoagulants before atrial fibrillation(AF)ablation can reduce the incidence of perioperative thromboembolic events.However,the effect of new oral anticoagulants on activated clotting time(ACT)in respo-nse to heparin during AF ablation in Chinese populations remains unknown.The aim of the present retrospective study was to investigate the value of ACTs in response to intraoperative heparin administration in patients using dabigatran or rivaroxaban.METHODS From January 2018 to December 2021,a total of 173 patients undergoing AF ablation were included in the study,in which 101 patients were treated with dabigatran,72 patients were treated with rivaroxaban.The intraoperative ACT values were examined in both groups.The incidence of periprocedural complications was evaluated.RESULTS Initial heparin dosage(88±19 U/kg vs.78±27 U/kg,P<0.05),total heparin dosage(137±41 U/kg vs.106±52 U/kg,P<0.05)during the ablation procedure were higher in the dabigatran group than those in the rivaroxaban group.Mean ACT(280±36 s vs.265±30 s,P<0.05),and the percentage of ACTs within the therapeutic range(250-350 s)(74%±26%vs.60%±29%,P<0.05)were significantly lower in the dabigatran group than those in the rivaroxaban group,particularly in male pati-ents.Furthermore,the average time of achieving the target ACT(250-350 s)was also found longer in the dabigatran group(P<0.05)as compared with the rivaroxaban group.No significant difference was found in the incidence of periprocedural complica-tions between the two groups.CONCLUSIONS The anticoagulant effect of uninterrupted rivaroxaban therapy appears to be more stable and efficient than dabigatran administration during catheter ablation in patients with AF.

Core muscle functional strength training for reducing the risk of low back pain in military recruits:An open-label randomized controlled trial

Background:Core muscle functional strength training(CMFST)has been reported to reduce injuries to the lower extremity.However,no study has confirmed whether CMFST can reduce the risk of low back pain(LBP).Objective:This study identified the effects of CMFST on the incidence of LBP in military recruits.Design,setting,participants and intervention:We performed a prospective,open-label,randomized,controlled study in a population of young healthy male naval recruits from a Chinese basic combat training program.Participants were randomly assigned to either the core group or the control group.In additional to normal basic combat training,recruits in the core group underwent a CMFST program for 12 weeks,while recruits in the control group received no extra training.Main outcome measures:At the beginning of the study and at the 12 th week,the number of participants with LBP was counted,and lumbar muscle endurance was measured.In addition,when participants complained of LBP,they were assessed using the visual analog scale(VAS)and Roland Morris Disability Questionnaire(RMDQ).Results:A total of 588 participants were included in the final analysis(295 in the core group and 293 in the control group).The incidence of LBP in the control group was about twice that of the core group over the 12-week study(20.8%vs 10.8%,odds ratio:2.161–2.159,P<0.001).The core group had better lumbar muscle endurance at 12 weeks than the control group([200.80±92.98]s vs[147.00±84.51]s,P<0.01).There was no significant difference in VAS score between groups,but the core group had a significantly lower RMDQ score at week 12 than the control group(3.33±0.58 vs 5.47±4.41,P<0.05).Conclusion:This study demonstrated that the CMFST effectively reduced the incidence of LBP,improved lumbar muscle endurance,and relieved the dysfunction of LBP during basic military training.