| 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. | |
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MedLine Citation:
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PMID: 16443257 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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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:
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Type: Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't Date: 2006-01-27 |
Journal Detail:
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Title: Thrombosis research Volume: 119 ISSN: 0049-3848 ISO Abbreviation: Thromb. Res. Publication Date: 2007 |
Date Detail:
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Created Date: 2006-11-20 Completed Date: 2007-03-07 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0326377 Medline TA: Thromb Res Country: United States |
Other Details:
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Languages: eng Pagination: 27-34 Citation Subset: IM |
Affiliation:
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Molecular Cardiology, JW Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany. schmidt-lucke@em.uni-frankfurt.de |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Anticoagulants / administration & dosage* Atrial Fibrillation / drug therapy* Cohort Studies Electric Countershock* Enoxaparin / administration & dosage* Heparin / administration & dosage* Humans International Normalized Ratio Partial Thromboplastin Time Phenprocoumon / pharmacology* Prospective Studies Thromboembolism / drug therapy*, prevention & control* Time Factors |
| Chemical | |
Reg. No./Substance:
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0/Anticoagulants; 0/Enoxaparin; 435-97-2/Phenprocoumon; 9005-49-6/Heparin |
| Comments/Corrections | |
Comment In:
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Thromb Res. 2007;119(3):275-6
[PMID:
16426666
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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