Document Detail

Quality of anticoagulation with unfractionated heparin plus phenprocoumon for the prevention of thromboembolic complications in cardioversion for non-valvular atrial fibrillation. Sub-analysis from the Anticoagulation in Cardioversion using Enoxaparin (ACE) trial.
MedLine Citation:
PMID:  16443257     Owner:  NLM     Status:  MEDLINE    
INTRODUCTION: Anticoagulation in cardioversion for atrial fibrillation is performed using unfractionated heparin and oral anticoagulants. TEE-guided cardioversion, after achievement of therapeutic anticoagulation (1-3 days), may be an alternative to the traditional procedure (3-week anticoagulation followed by cardioversion). The quality of anticoagulation in atrial fibrillation has not been investigated in a randomised trial with TEE-guided cardioversion. We analysed respective data from the ACE trial on the quality of conventional anticoagulation, where most participating centres chose the TEE-guided approach. MATERIALS AND METHODS: In a randomised, prospective, multicentre trial, we analysed the efficacy of unfractionated heparin plus phenprocoumon in 248 patients on an intention-to-treat basis. There were 2373 evaluable anticoagulation measurements (out of 2925 measurements) and 4 categories of anticoagulation quality (under-, target, over- and severe over-anticoagulation). Of patients with evaluable measurements, 88% received short-term anticoagulation (4 weeks) in TEE-guided cardioversion. RESULTS: The median time to achieve therapeutic anticoagulation (aPTT> or =60 and <80 s or INR> or =2 and <3) was 3 days. Anticoagulation values were out of therapeutic range in 69.5% of measurements during 4- or 7-week follow-up, and never within therapeutic range in 10% of patients. Of the 15 primary endpoints observed (death, thromboembolism and major bleeding complications), only 3 were in patients with anticoagulation measurements within therapeutic range. CONCLUSIONS: In this study setting, with predominance of 4 weeks anticoagulation in TEE-guided cardioversion for atrial fibrillation, therapeutic anticoagulation was reached within 3 days using conventional anticoagulation. Despite careful dose adjustments, anticoagulation was out of therapeutic range in almost 70% of total measurements and 80% of primary endpoints.
Caroline Schmidt-Lucke; W Dieter Paar; Christoph Stellbrink; Uwe Nixdorff; Thomas Hofmann; Jürgen Meurer; Rolf Grewe; Werner Günther Daniel; Peter Hanrath; Andreas Mügge; Helmut U Klein; Jan André Schmidt-Lucke
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Publication Detail:
Type:  Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2006-01-27
Journal Detail:
Title:  Thrombosis research     Volume:  119     ISSN:  0049-3848     ISO Abbreviation:  Thromb. Res.     Publication Date:  2007  
Date Detail:
Created Date:  2006-11-20     Completed Date:  2007-03-07     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0326377     Medline TA:  Thromb Res     Country:  United States    
Other Details:
Languages:  eng     Pagination:  27-34     Citation Subset:  IM    
Molecular Cardiology, JW Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany.
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MeSH Terms
Anticoagulants / administration & dosage*
Atrial Fibrillation / drug therapy*
Cohort Studies
Electric Countershock*
Enoxaparin / administration & dosage*
Heparin / administration & dosage*
International Normalized Ratio
Partial Thromboplastin Time
Phenprocoumon / pharmacology*
Prospective Studies
Thromboembolism / drug therapy*,  prevention & control*
Time Factors
Reg. No./Substance:
0/Anticoagulants; 0/Enoxaparin; 435-97-2/Phenprocoumon; 9005-49-6/Heparin
Comment In:
Thromb Res. 2007;119(3):275-6   [PMID:  16426666 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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