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

Lambert A. Wu, Krishnaswamy Chandrasekaran, Paul Andrew Friedman, Naser M. Ammash, Gautam Ramakrishna, C. Y T Hart, Brenda S. Moon, Regina M. Herges, A. Gabriela Rosales, Joseph F. Malouf

Research output: Contribution to journalArticle

11 Citations (Scopus)

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 2006

Fingerprint

Electric Countershock
Heparin
Low Molecular Weight Heparin
Safety
Transesophageal Echocardiography
Atrial Flutter
Atrial Fibrillation
Therapeutics
Stroke
International Normalized Ratio
Cause of Death
Hemorrhage

Keywords

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

ASJC Scopus subject areas

  • Nursing(all)

Cite this

Safety of expedited anticoagulation in patients undergoing transesophageal echocardiographic-guided cardioversion. / Wu, Lambert A.; Chandrasekaran, Krishnaswamy; Friedman, Paul Andrew; Ammash, Naser M.; Ramakrishna, Gautam; Hart, C. Y T; Moon, Brenda S.; Herges, Regina M.; Rosales, A. Gabriela; Malouf, Joseph F.

In: American Journal of Medicine, Vol. 119, No. 2, 02.2006, p. 142-146.

Research output: Contribution to journalArticle

Wu, LA, Chandrasekaran, K, Friedman, PA, Ammash, NM, Ramakrishna, G, Hart, CYT, Moon, BS, Herges, RM, Rosales, AG & Malouf, JF 2006, 'Safety of expedited anticoagulation in patients undergoing transesophageal echocardiographic-guided cardioversion', American Journal of Medicine, vol. 119, no. 2, pp. 142-146. https://doi.org/10.1016/j.amjmed.2005.06.029
Wu, Lambert A. ; Chandrasekaran, Krishnaswamy ; Friedman, Paul Andrew ; Ammash, Naser M. ; Ramakrishna, Gautam ; Hart, C. Y T ; Moon, Brenda S. ; Herges, Regina M. ; Rosales, A. Gabriela ; Malouf, Joseph F. / Safety of expedited anticoagulation in patients undergoing transesophageal echocardiographic-guided cardioversion. In: American Journal of Medicine. 2006 ; Vol. 119, No. 2. pp. 142-146.
@article{486b3a8f6aff442e9cf24fda9f4787d0,
title = "Safety of expedited anticoagulation in patients undergoing transesophageal echocardiographic-guided cardioversion",
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.",
keywords = "Cardioversion, Low-molecular-weight heparin, Transesophageal echocardiography",
author = "Wu, {Lambert A.} and Krishnaswamy Chandrasekaran and Friedman, {Paul Andrew} and Ammash, {Naser M.} and Gautam Ramakrishna and Hart, {C. Y T} and Moon, {Brenda S.} and Herges, {Regina M.} and Rosales, {A. Gabriela} and Malouf, {Joseph F.}",
year = "2006",
month = "2",
doi = "10.1016/j.amjmed.2005.06.029",
language = "English (US)",
volume = "119",
pages = "142--146",
journal = "American Journal of Medicine",
issn = "0002-9343",
publisher = "Elsevier Inc.",
number = "2",

}

TY - JOUR

T1 - Safety of expedited anticoagulation in patients undergoing transesophageal echocardiographic-guided cardioversion

AU - Wu, Lambert A.

AU - Chandrasekaran, Krishnaswamy

AU - Friedman, Paul Andrew

AU - Ammash, Naser M.

AU - Ramakrishna, Gautam

AU - Hart, C. Y T

AU - Moon, Brenda S.

AU - Herges, Regina M.

AU - Rosales, A. Gabriela

AU - Malouf, Joseph F.

PY - 2006/2

Y1 - 2006/2

N2 - 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.

AB - 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.

KW - Cardioversion

KW - Low-molecular-weight heparin

KW - Transesophageal echocardiography

UR - http://www.scopus.com/inward/record.url?scp=31444439630&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=31444439630&partnerID=8YFLogxK

U2 - 10.1016/j.amjmed.2005.06.029

DO - 10.1016/j.amjmed.2005.06.029

M3 - Article

C2 - 16443416

AN - SCOPUS:31444439630

VL - 119

SP - 142

EP - 146

JO - American Journal of Medicine

JF - American Journal of Medicine

SN - 0002-9343

IS - 2

ER -