Prevalence of atrial thrombi in patients with atrial fibrillation/flutter and subtherapeutic anticoagulation prior to cardioversion

Autor: G. Tadeo, S Beretta, Mauro Santarone, L M Tagliagambe, Giovanni Corrado, G Foglia-Manzillo, L Sormani
Rok vydání: 2004
Předmět:
Male
medicine.medical_specialty
medicine.medical_treatment
Electric Countershock
Cardioversion
Predictive Value of Tests
Thromboembolism
Internal medicine
Atrial Fibrillation
Prevalence
medicine
Humans
Radiology
Nuclear Medicine and imaging
Heart Atria
International Normalized Ratio
cardiovascular diseases
Atrium (heart)
Thrombus
Aged
Retrospective Studies
business.industry
Warfarin
Anticoagulants
Retrospective cohort study
Atrial fibrillation
Arteries
General Medicine
Middle Aged
medicine.disease
Combined Modality Therapy
Treatment Outcome
medicine.anatomical_structure
Atrial Flutter
Italy
Echocardiography
Predictive value of tests
External cephalic version
Anesthesia
Cardiology
Female
Cardiology and Cardiovascular Medicine
business
Biomarkers
Echocardiography
Transesophageal
Follow-Up Studies
medicine.drug
Zdroj: European Journal of Echocardiography. 5:257-261
ISSN: 1525-2167
Popis: Aims Thromboembolism may complicate electrical cardioversion (ECV) of atrial fibrillation/flutter (AF). The use of 3 weeks of warfarin before ECV results in a substantial reduction of thromboembolic complications. Nevertheless, in patients scheduled for ECV subtherapeutic INR levels are common. We sought to assess the prevalence and the predictors of atrial thrombi in patients affected with sustained AF in whom subtherapeutic INR values were detected in the 3 weeks preceding scheduled ECV. Methods and results Forty-one patients with persistent AF and > or =3 weeks warfarin anticoagulation who exhibited subtherapeutic INR values in the last 3 weeks underwent a transoesophageal echocardiogram (TOE) before a scheduled ECV. A left atrial appendage (LAA) thrombus was diagnosed on TOE in four patients (9.8%). Patients with thrombus had lower INR values (1.45+/-0.09 vs 1.72+/-0.20; p=0.0068), lower LAA emptying velocities (13.75+/-4.5 vs 25.86+/-12.4 cm/s; p=0.0313) and higher prevalence of atrial smoke (100 vs 37.8%,p=0.03). Conclusions Subtherapeutic levels of anticoagulation before elective ECV of AF may expose patients to post-ECV thromboembolic sequelae, especially in patients with lowest INR values. Current recommendations of a full course of therapeutic anticoagulation before ECV of persistent AF should be firmly observed.
Databáze: OpenAIRE
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