| Safety of expedited anticoagulation in patients undergoing transesophageal echocardiographic-guided cardioversion. | |
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MedLine Citation:
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PMID: 16443416 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: In patients undergoing transesophageal echocardiography-guided cardioversion, we evaluated the use and safety of an expedited in-hospital anticoagulation regimen that incorporates shorter-than-standard durations of precardioversion intravenous unfractionated heparin and postcardioversion bridging therapy with a low-molecular-weight heparin. METHODS: Adult patients who underwent successful transesophageal echocardiography-guided cardioversion for atrial fibrillation or atrial flutter between May 2000 and August 2003 were classified into 2 groups by duration of intravenous unfractionated heparin therapy (<24 h or > or =24 h) before transesophageal echocardiography and cardioversion. Safety end points evaluated included all-cause death, stroke or other thromboembolic events, and major bleeding complications within 1 month after successful cardioversion. RESULTS: The study population of 386 patients included 199 (52%) who received expedited intravenous unfractionated heparin (<24 h; minimum duration, <4 h) and 193 patients (50%) who were discharged on low-molecular-weight heparin therapy. The adverse event rates at 1-month follow-up were not significantly different between the 2 unfractionated heparin patient groups, and the rate of stroke among patients dismissed on low-molecular-weight heparin was less than 1%. No adverse events occurred among patients who received intravenous unfractionated heparin for less than 12 hours and who were dismissed on low-molecular-weight heparin bridging therapy. CONCLUSIONS: The use of an expedited heparin anticoagulation regimen in patients with atrial fibrillation or atrial flutter undergoing transesophageal echocardiography-guided cardioversion appears to be safe. Cardioversion can be performed as early as a few hours after initiation of intravenous unfractionated heparin, and bridging therapy with a low-molecular-weight heparin can be used after cardioversion until the international normalized ratio is therapeutic. |
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Authors:
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Lambert A Wu; Krishnaswamy Chandrasekaran; Paul A Friedman; Naser M Ammash; Gautam Ramakrishna; Chari Y T Hart; Brenda S Moon; Regina M Herges; A Gabriela Rosales; Joseph F Malouf |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: The American journal of medicine Volume: 119 ISSN: 1555-7162 ISO Abbreviation: Am. J. Med. Publication Date: 2006 Feb |
Date Detail:
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Created Date: 2006-01-30 Completed Date: 2006-02-27 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0267200 Medline TA: Am J Med Country: United States |
Other Details:
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Languages: eng Pagination: 142-6 Citation Subset: AIM; IM |
Affiliation:
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Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minn 55905, USA. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Aged Anticoagulants / administration & dosage*, adverse effects Atrial Fibrillation / physiopathology, therapy*, ultrasonography Atrial Flutter / physiopathology, therapy*, ultrasonography Echocardiography, Transesophageal* Electric Countershock* Heparin / administration & dosage*, adverse effects Heparin, Low-Molecular-Weight / administration & dosage, adverse effects Humans Infusions, Intravenous Injections, Intravenous International Normalized Ratio Ultrasonography, Interventional |
| Chemical | |
Reg. No./Substance:
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0/Anticoagulants; 0/Heparin, Low-Molecular-Weight; 9005-49-6/Heparin |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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