Optimal Anticoagulation Strategy for Cardioversion in Atrial Fibrillation

Bushoven, Philipp; Linzbach, Sven; Vámos, Máté; Hohnloser, Stefan H.

doi:10.15420/aer.2015.4.1.44

Cited by 3 publications

(2 citation statements)

References 23 publications

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“…Therefore, the duration of preparation for scheduled cardioversion lasts from two to three months [ 8 , 9 ]. The action of NOACs is stable, dosage is simple, preparation for scheduled SR restoration is shorter.…”

Section: Introductionmentioning

confidence: 99%

Findings of transoesophageal echocardiogram in appropriately anticoagulated patients with persistent atrial fibrillation prior to planned cardioversion

Barysienė

Žebrauskaitė

Petrikonytė

et al. 2017

BMC Cardiovasc Disord

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BackgroundTo evaluate a diagnostic value of transoesophageal echocardiogram (TEE) in appropriately anticoagulated patients with a non-valvular atrial fibrillation (AF) and to establish possible additional indications for TEE; to evaluate the incidence of left atrial (LA) thrombi in appropriately anticoagulated patients in daily clinical practice.MethodsThis retrospective study analyses data of 432 patients who had been anticoagulated by means of oral anticoagulants (OACs) prior to planned cardioversion during the period from 2012 to 2015. Thromboembolic (TE) and bleeding risks were assessed using CHA2DS2-VASc and HAS-BLED scores. Transthoracic and transoesophageal echocardiograms were evaluated. TE complications during 30 days after discharge were assessed.Results432 patients were selected, aged from 22 to 89 years (mean 65.0 ±11.5), 277 (64.1%) males and 155 (35.9%) females, 306 (70.8%) on warfarin and 126 (29.2%) on non-vitamin K antagonist oral anticoagulants (NOAC). Mean CHA2DS2-VASc score was 3.5 ±1.5. TEE was performed for 120 (27.8%) patients, more frequently for patients on NOACs and for ones with III° LA enlargement.TEE revealed LA thrombi in seven (5.8%) of the patients. In warfarin and NOACs groups thrombi were revealed in five (7.0%) and two (4.1%) patients, respectively. TEE did not reveal any thrombi in patients with normal left ventricular (LV) function; however, thrombi were found in two (6.1%) patients with slightly decreased LV function, and in five (17.9%) patients with markedly decreased LV function.In patients with decreased left ventricular ejection fraction (LVEF) thrombi in LA were found more frequently than in patients with normal and slightly decreased LVEF (17.9% vs 2.2%, p=0.008). CHA2DS2-VASc score of all 7 patients was ≥5. None of the patients after cardioversion had TE complications 30 days after discharge.ConclusionsThe risk of LA thrombi in patients prepared for scheduled cardioversion in line with the guidelines is low. Higher risk of thrombi was present in patients with decreased LVEF (≤40%), CHA2DS2-VASc ≥5. In order to assess more accurately indications to perform TEE for appropriately anticoagulated patients prior to scheduled cardioversion a study with larger number of patients is required.

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Section: Introductionmentioning

confidence: 99%

Findings of transoesophageal echocardiogram in appropriately anticoagulated patients with persistent atrial fibrillation prior to planned cardioversion

Barysienė

Žebrauskaitė

Petrikonytė

et al. 2017

BMC Cardiovasc Disord

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“…2019; 6(9), 676-679. DOI: 10.18410/jebmh/2019/141 BACKGROUND Oral anticoagulants are often indicated for the prophylaxis or treatment of venous thromboembolism (VTE) including deep vein thrombosis (DVT) and pulmonary embolism (PE); 1 Atrial fibrillation; 2 Cardioversion; 3 Valvular heart disease; 4 Acute coronary syndrome; 5 cardiomyopathy 6 and rarely peripheral vascular disease. 7,8,9,10 Vitamin K antagonist (VKA) -warfarin has ruled this field for more than half century since its approval in 1954.…”

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confidence: 99%

A Six Year Drug Utilization Study in a Tertiary Healthcare System: Emergence of Newer Oral Anticoagulants

Tejus¹

2019

jebmh

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BACKGROUNDVitamin K antagonists like warfarin have been used extensively for various medical and surgical conditions. Their use is often associated with bleeding as an adverse effect. Novel oral anticoagulants like dabigatran, rivaroxaban, apixaban achieve anticoagulation with relatively less risk of bleeding and the availability of reversal agents.The present study aims to study the drug consumption pattern of oral anticoagulants and analyses the change in pattern of prescription. MATERIALS AND METHODSThe consumption pattern of oral anticoagulants was analysed from the prescriptions over a period of six years from 2013 to 2018 in a busy tertiary care centre. RESULTSThe analysis of 12,05,000 prescriptions reveal that the use of warfarin dropped from 45.64% in 2013 to 7.17% in 2018. Similarly, there was a gradual rise in the use of NOAC from 3.14% in 2013 to 73.72% in 2018. CONCLUSIONNovel oral anticoagulants like dabigatran, rivaroxaban, apixaban are gradually emerging as the preferred anticoagulants, along with a steady decline in the prescription of warfarin.

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Breaking habits: safety and efficacy of elective electrocardioversion of atrial fibrillation and atrial flutter in the setting of day hospital

Brkić,

Bećirović,

Bećirović

et al. 2023

Medicinski Glasnik

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Aim To examine safety and efficiency of electrocardioversion (EC) in elective treatment of atrial fibrillation and atrial flutter in the setting of Day Hospital by determining success rate, frequency of adverse events and possible cost benefit compared to admitting a patient into hospital. Methods This prospective observational cohort study was performed in Day Hospital and in Intensive Care Department of Internal Medicine Clinic, University Clinical Centre Tuzla from January 2019 to December 2022 and included 98 patients with a persistent form of atrial fibrillation (AF) or atrial flutter. The patients who were divided in two groups, 56 hospitalized and 42 patients accessed in Day Hospital. In all patients, medical history, physical examination, electrocardiogram (ECG) and transthoracic echocardiogram (TTE) evaluation was performed in addition to laboratory findings. Electrocardioversion was performed with a monophasic General Electric defibrillator in anterolateral electrode position with up to three repetitive shocks. Results In hospital setting group overall succes rate of electrocardioversion was 85%, with average 2.1 EC attemps, there was with one fatal outcome due to stroke, one case of ventricular fibrillation (VF) due to human error, and 6 minor adverse events; with average cost of was 1408.70 KM (720.23 &euro;) per patient. In Day Hospital setting succes rate was 88%, with average 2 EC attempts, no major adverse events, 8 minor adverse events; and average cost was of 127.23 KM (65.05 &euro;) per patient. Conclusion Performing elective electrocardioversion in Day Hospital setting is as safe as admitting patients into hospital but substantially more cost effective.

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Optimal Anticoagulation Strategy for Cardioversion in Atrial Fibrillation

Cited by 3 publications

References 23 publications

Findings of transoesophageal echocardiogram in appropriately anticoagulated patients with persistent atrial fibrillation prior to planned cardioversion

Findings of transoesophageal echocardiogram in appropriately anticoagulated patients with persistent atrial fibrillation prior to planned cardioversion

A Six Year Drug Utilization Study in a Tertiary Healthcare System: Emergence of Newer Oral Anticoagulants

Breaking habits: safety and efficacy of elective electrocardioversion of atrial fibrillation and atrial flutter in the setting of day hospital

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