Safety of expedited anticoagulation in patients undergoing transesophageal echocardiographic-guided cardioversion

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

Research output: Contribution to journalArticle

11 Scopus citations

Abstract

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 ≥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.

Original languageEnglish (US)
Pages (from-to)142-146
Number of pages5
JournalAmerican Journal of Medicine
Volume119
Issue number2
DOIs
StatePublished - Feb 1 2006

Keywords

  • Cardioversion
  • Low-molecular-weight heparin
  • Transesophageal echocardiography

ASJC Scopus subject areas

  • Medicine(all)

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    Wu, L. A., Chandrasekaran, K., Friedman, P. A., Ammash, N. M., Ramakrishna, G., Hart, C. Y. T., Moon, B. S., Herges, R. M., Rosales, A. G., & Malouf, J. F. (2006). Safety of expedited anticoagulation in patients undergoing transesophageal echocardiographic-guided cardioversion. American Journal of Medicine, 119(2), 142-146. https://doi.org/10.1016/j.amjmed.2005.06.029