Stellbrink Christoph, Nixdorff Uwe, Hofmann Thomas, Lehmacher Walter, Daniel Werner Günther, Hanrath Peter, Geller Christoph, Mügge Andreas, Sehnert Walter, Schmidt-Lucke Caroline, Schmidt-Lucke Jan-André
Rheinisch-Westfälische Technische Hochschule Aachen.
Card Electrophysiol Rev. 2003 Dec;7(4):382-6. doi: 10.1023/B:CEPR.0000023145.54503.a2.
The mode and duration of anticoagulation in the setting of cardioversion of atrial fibrillation-either with or without guidance by transesophageal echocardiography (TEE)-is still an unresolved issue. Oral anticoagulation with warfarin or phenprocoumon is frequently used but may be associated with an increased risk of bleeding complications or, conversely, episodes of undercoagulation. Moreover, it takes several days to reach full anticoagulation with oral compounds. This phase may be covered with intravenous heparin but this requires prolonged hospitalization. Low-molecular weight heparin is an attractive alternative as it not only provides a safe and predictable level of anticoagulation with few side effects but can also be administered safely on an outpatient basis. In addition, anticoagulation monitoring is usually unnecessary. The ACE study (Anticoagulation in Cardioversion using Enoxaparin) compared the safety and efficacy of subcutaneous enoxaparin with intravenous heparin/oral phenprocoumon before and after cardioversion (stratified to TEE guidance or no TEE guidance). This article summarizes the study rationale and design. The results will be published shortly.
在心房颤动复律过程中，无论有无经食管超声心动图（TEE）引导，抗凝的方式和持续时间仍是一个尚未解决的问题。华法林或苯丙香豆素的口服抗凝治疗经常被使用，但可能会增加出血并发症的风险，或者相反，出现抗凝不足的情况。此外，口服药物达到完全抗凝需要几天时间。这一阶段可用静脉注射肝素覆盖，但这需要延长住院时间。低分子量肝素是一种有吸引力的替代方法，因为它不仅能提供安全且可预测的抗凝水平，副作用少，还能在门诊安全给药。此外，通常无需进行抗凝监测。ACE研究（使用依诺肝素进行复律时的抗凝治疗）比较了皮下注射依诺肝素与静脉注射肝素/口服苯丙香豆素在复律前后的安全性和有效性（分为TEE引导组或无TEE引导组）。本文总结了该研究的基本原理和设计。研究结果将很快发表。
