经食管超声心动图引导下心脏复律患者快速抗凝治疗的安全性

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

作者信息

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

机构信息

Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minn 55905, USA.

出版信息

Am J Med. 2006 Feb;119(2):142-6. doi: 10.1016/j.amjmed.2005.06.029.

DOI:10.1016/j.amjmed.2005.06.029

PMID:16443416

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 > 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.

摘要

背景

在接受经食管超声心动图引导下心脏复律的患者中，我们评估了一种加速院内抗凝方案的使用情况及安全性，该方案采用短于标准疗程的复律前静脉注射普通肝素及复律后用低分子量肝素进行桥接治疗。

方法

2000年5月至2003年8月间成功接受经食管超声心动图引导下房颤或房扑心脏复律的成年患者，根据经食管超声心动图及心脏复律前静脉注射普通肝素治疗的疗程（<24小时或≥24小时）分为两组。评估的安全性终点包括成功复律后1个月内的全因死亡、卒中或其他血栓栓塞事件以及严重出血并发症。

结果

386例研究对象中，199例（52%）接受了加速静脉注射普通肝素（<24小时；最短疗程<4小时），193例（50%）出院时接受低分子量肝素治疗。两组普通肝素治疗患者1个月随访时的不良事件发生率无显著差异，出院时接受低分子量肝素治疗患者的卒中发生率低于1%。接受静脉注射普通肝素少于12小时且出院时接受低分子量肝素桥接治疗的患者未发生不良事件。