Document Detail

Safety of expedited anticoagulation in patients undergoing transesophageal echocardiographic-guided cardioversion.
MedLine Citation:
PMID:  16443416     Owner:  NLM     Status:  MEDLINE    
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.
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:
Type:  Journal Article    
Journal Detail:
Title:  The American journal of medicine     Volume:  119     ISSN:  1555-7162     ISO Abbreviation:  Am. J. Med.     Publication Date:  2006 Feb 
Date Detail:
Created Date:  2006-01-30     Completed Date:  2006-02-27     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0267200     Medline TA:  Am J Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  142-6     Citation Subset:  AIM; IM    
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minn 55905, USA.
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MeSH Terms
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
Infusions, Intravenous
Injections, Intravenous
International Normalized Ratio
Ultrasonography, Interventional
Reg. No./Substance:
0/Anticoagulants; 0/Heparin, Low-Molecular-Weight; 9005-49-6/Heparin

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