Tapio Hellman1, Tuomas Kiviniemi2, Ilpo Nuotio3, Tuija Vasankari2, Juha Hartikainen4, Gregory Y H Lip5, K E Juhani Airaksinen6. 1. Heart Center, Turku University Hospital and University of Turku, Hämeentie 11, PO Box 52, 20521 Turku, Finland; Department of Medicine, Turku University Hospital and University of Turku, Hämeentie 11, PO Box 52, 20521 Turku, Finland. 2. Heart Center, Turku University Hospital and University of Turku, Hämeentie 11, PO Box 52, 20521 Turku, Finland. 3. Department of Medicine, Turku University Hospital and University of Turku, Hämeentie 11, PO Box 52, 20521 Turku, Finland. 4. Heart Center, Kuopio University Hospital and University of Eastern Finland, PO Box 100, 70029, Finland. 5. University of Birmingham, Institute of Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom; Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark. 6. Heart Center, Turku University Hospital and University of Turku, Hämeentie 11, PO Box 52, 20521 Turku, Finland. Electronic address: juhani.airaksinen@tyks.fi.
Abstract
BACKGROUND: Elective cardioversion (ECV) for atrial fibrillation (AF) is associated with a relatively low risk of thromboembolic complications. However, the optimal intensity of anticoagulation for ECV is unknown. We sought to assess the risk of thromboembolism in low (INR 2.0-2.4) vs. high (INR≥2.5) therapeutic range in a large retrospective cohort study. METHODS: This multi-centre "real world" study included 1424 ECVs in 1021 patients. The primary outcome was a stroke or a transient ischaemic attack (TIA) or a systemic embolus during the 30-day follow-up after ECV. RESULTS: Altogether 4 (0.3%) strokes, 2 (0.1%) TIAs and 2 (0.1%) bleeds were detected during the 30-day follow-up after ECV. No systemic emboli were detected. There were 2 deaths (0.1%), one associated with a stroke. Median time to stroke/TIA was 4 (IQR 9.5) days and the median CHA2DS2-VASc-score was 2 (IQR 1.25) among patients with thromboembolic events. Mean INR at ECV was 2.7 (SD 0.54) in the study cohort. Patients with INR 2.0-2.4 at ECV had more thromboembolic events compared with patients with INR≥2.5 (5/529 (0.9%) vs. 1/895 (0.1%), p=0.03). Comprehensive postprocedural INR data was available for 733 (71.8%) patients and 1007 cardioversions. At least one subtherapeutic (<2.0) INR value was detected within 21days after 230 (22.8%) ECVs and this drop in INR level was associated with a higher risk for thromboembolic events compared with continuous therapeutic post-cardioversion anticoagulation (1.7% vs 0.3%, p=0.03). CONCLUSIONS: Our results suggest that the intensity of periprocedural anticoagulation is associated with the risk of thromboembolic events after ECV.
BACKGROUND: Elective cardioversion (ECV) for atrial fibrillation (AF) is associated with a relatively low risk of thromboembolic complications. However, the optimal intensity of anticoagulation for ECV is unknown. We sought to assess the risk of thromboembolism in low (INR 2.0-2.4) vs. high (INR≥2.5) therapeutic range in a large retrospective cohort study. METHODS: This multi-centre "real world" study included 1424 ECVs in 1021 patients. The primary outcome was a stroke or a transient ischaemic attack (TIA) or a systemic embolus during the 30-day follow-up after ECV. RESULTS: Altogether 4 (0.3%) strokes, 2 (0.1%) TIAs and 2 (0.1%) bleeds were detected during the 30-day follow-up after ECV. No systemic emboli were detected. There were 2 deaths (0.1%), one associated with a stroke. Median time to stroke/TIA was 4 (IQR 9.5) days and the median CHA2DS2-VASc-score was 2 (IQR 1.25) among patients with thromboembolic events. Mean INR at ECV was 2.7 (SD 0.54) in the study cohort. Patients with INR 2.0-2.4 at ECV had more thromboembolic events compared with patients with INR≥2.5 (5/529 (0.9%) vs. 1/895 (0.1%), p=0.03). Comprehensive postprocedural INR data was available for 733 (71.8%) patients and 1007 cardioversions. At least one subtherapeutic (<2.0) INR value was detected within 21days after 230 (22.8%) ECVs and this drop in INR level was associated with a higher risk for thromboembolic events compared with continuous therapeutic post-cardioversion anticoagulation (1.7% vs 0.3%, p=0.03). CONCLUSIONS: Our results suggest that the intensity of periprocedural anticoagulation is associated with the risk of thromboembolic events after ECV.
Authors: Tapio Hellman; Tuomas Kiviniemi; Ilpo Nuotio; Fausto Biancari; Tuija Vasankari; Juha Hartikainen; Mika Lehto; K E Airaksinen Journal: Clin Cardiol Date: 2018-07-23 Impact factor: 2.882
Authors: Jean C Nuñez-Garcia; Antonio Sánchez-Puente; Jesús Sampedro-Gómez; Victor Vicente-Palacios; Manuel Jiménez-Navarro; Armando Oterino-Manzanas; Javier Jiménez-Candil; P Ignacio Dorado-Diaz; Pedro L Sánchez Journal: J Clin Med Date: 2022-05-07 Impact factor: 4.964
Authors: Samiullah Arshad; George A Davis; Muhammad Amir; Ythan H Goldberg; Vedant A Gupta; Ahmed K Abdel-Latif; Susan Smyth Journal: Cardiol Res Date: 2022-03-12