Post-cardioversion transesophageal echocardiography (POSTEC) strategy with use of enoxaparin for brief anticoagulation in atrial fibrillation patients: the multicenter POSTEC trial (a pilot study)

Autor: Giacinto Pettinati, Margherita Sorino, Vincenzo Montericcio, Esmeralda Oliva, Leonardo De Luca, Flaviano Iacopi, Carlo D'Agostino, Salvatore Mario De Tommasi, Paolo Colonna, Scipione Carerj, Nicola D’Amato, Annamaria Cualbu, Italo de Luca, Umberto Conti
Jazyk: angličtina
Rok vydání: 2007
Předmět:
Male
medicine.medical_specialty
Time Factors
medicine.drug_class
medicine.medical_treatment
Electric Countershock
Administration
Oral
Low molecular weight heparin
Pilot Projects
Cardioversion
Risk Assessment
Drug Administration Schedule
Sudden cardiac death
law.invention
Randomized controlled trial
law
Thromboembolism
Internal medicine
Atrial Fibrillation
medicine
Humans
Prospective Studies
Enoxaparin
Prospective cohort study
Atrial fibrillation
Atrial stunning
Transesophageal echocardiography
Aged
Heparin
business.industry
Patient Selection
Anticoagulants
General Medicine
Middle Aged
medicine.disease
Clinical trial
Treatment Outcome
Italy
Research Design
Cardiology
Feasibility Studies
Female
Cardiology and Cardiovascular Medicine
business
human activities
Echocardiography
Transesophageal
medicine.drug
Popis: Objectives In patients with atrial fibrillation (AF), we sought to evaluate the feasibility and safety of a new transesophageal echocardiography (TEE)-guided strategy, aimed at selecting, 7 days post-cardioversion, those patients who are at low risk (i.e. who can terminate anticoagulation after a second TEE) and those at high risk (i.e. who have to continue it). Methods We enrolled 206 patients with non-valvular AF into a randomized, multicenter clinical trial. Group A patients underwent a TEE-guided cardioversion with heparin and at least 4 weeks of oral anticoagulation therapy (OAT) after cardioversion. Group B patients received enoxaparin and underwent a TEE-guided cardioversion. After 7 days, a second TEE was carried out. In the absence of TEE thromboembolic risk factors and left atrial appendage (LAA) dysfunction anticoagulation was discontinued. Results In group A, 88 out of 102 patients underwent TEE and cardioversion was efficacious in 77 of 78. In group B, 100 out of 104 patients underwent TEE and cardioversion was efficacious in 80 of 87 patients; 55 patients underwent the second TEE and enoxaparin was stopped in 50 without LAA dysfunction. In group A, one transient ischemic attack and one sudden cardiac death occurred. In group B, one patient with complex aortic plaques suffered a stroke during enoxaparin. There was a minor hemorrhage in groups A and B, and a severe hemorrhage in a patient during OAT because of persistent atrial stunning. Hospitalization length and duration of anticoagulation were significantly shorter in group B. Conclusions The pre/post-cardioversion TEE strategy with enoxaparin in AF may constitute a feasible and safe approach in selecting patients at low thromboembolic risk who can benefit from precocious termination of anticoagulation (7 days after cardioversion). It may be also useful to identify those patients in whom a life-lasting anticoagulation could be beneficial. A larger trial to confirm these findings is under way.
Databáze: OpenAIRE
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