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 |
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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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