title: Safety of expedited anticoagulation in patients undergoing transesophageal echocardiographic-guided cardioversion.
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.
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minn 55905, USA.
authors.forename: Lambert A
authors.initials: LA
authors.lastname: Wu
authors.forename: Krishnaswamy
authors.initials: K
authors.lastname: Chandrasekaran
authors.forename: Paul A
authors.initials: PA
authors.lastname: Friedman
authors.forename: Naser M
authors.initials: NM
authors.lastname: Ammash
authors.forename: Gautam
authors.initials: G
authors.lastname: Ramakrishna
authors.forename: Chari Y T
authors.initials: CY
authors.lastname: Hart
authors.forename: Brenda S
authors.initials: BS
authors.lastname: Moon
authors.forename: Regina M
authors.initials: RM
authors.lastname: Herges
authors.forename: A Gabriela
authors.initials: AG
authors.lastname: Rosales
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Malouf
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D001282:Atrial Flutter / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D017548:Echocardiography, Transesophageal; D004554:Electric Countershock; D006493:Heparin / Q000008:administration & dosage* / Q000009:adverse effects; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D007262:Infusions, Intravenous; D007275:Injections, Intravenous; D019934:International Normalized Ratio; D018084:Ultrasonography, Interventional
chemical_list: D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D006493:Heparin