INTRODUCTION: Systemic embolism is the most serious complication of cardioversion of atrial fibrillation (AF) and the immediate post-cardioversion period is associated with increased risk for thrombus formation. For this reason, treatment with vitamin K antagonist (VKA) is recommended for patients with AF. No information is available about bleeding risk related to this practice. METHODS: We performed a prospective multicentre study on 242 low-risk AF patients (CHADS(2) score 0-1) that started on warfarin for elective cardioversion to evaluate their bleeding risk. RESULTS: 178 were males (73.6%), mean age 63.9 ± 9.8 years, 60 patients (25%) were aged ≤ 59 years. Patients with CHADS(2) score = 0 were 73 (30%), those with CHADS(2) score = 1 were 169 (70%). Patients were on VKA treatment, maintained at INR intended therapeutic range 2.0-3.0, for a median time of 159 days (range 30-631)total follow-up period 127 patient-years (pt-yrs). Quality of anticoagulation and occurrence of bleeding events were recorded. Patients spent 23%, 64% and 8% of time below, within and above the intended therapeutic range, respectively. When we observed the INR levels, we found that 62 patients (25.6%) had INR>4.5 at least in one occasion, and 23 (9.5%) in ≥ 2. During follow-up, 2 patients had major bleeds (rate 1.6% pt-yrs), one fatal. No embolic complications were recorded. CONCLUSION: Our results show that low-risk AF patients, treated with VKA for elective cardioversion, carry a not irrelevant risk of bleeding. Efforts are required to properly select patients who could benefit from this procedure, reducing the time of warfarin exposure.
Risk of bleeding in low-risk atrial fibrillation patients on warfarin waiting for elective cardioversion / Poli, Daniela; Antonucci, Emilia; Grifoni, Elisa; Paoletti, Oriana; Rancan, Elena; Dentali, Francesco; Testa, Sophie. - In: THROMBOSIS RESEARCH. - ISSN 0049-3848. - STAMPA. - 129:(2012), pp. 588-590. [10.1016/j.thromres.2011.08.031]
Risk of bleeding in low-risk atrial fibrillation patients on warfarin waiting for elective cardioversion
GRIFONI, ELISA;
2012
Abstract
INTRODUCTION: Systemic embolism is the most serious complication of cardioversion of atrial fibrillation (AF) and the immediate post-cardioversion period is associated with increased risk for thrombus formation. For this reason, treatment with vitamin K antagonist (VKA) is recommended for patients with AF. No information is available about bleeding risk related to this practice. METHODS: We performed a prospective multicentre study on 242 low-risk AF patients (CHADS(2) score 0-1) that started on warfarin for elective cardioversion to evaluate their bleeding risk. RESULTS: 178 were males (73.6%), mean age 63.9 ± 9.8 years, 60 patients (25%) were aged ≤ 59 years. Patients with CHADS(2) score = 0 were 73 (30%), those with CHADS(2) score = 1 were 169 (70%). Patients were on VKA treatment, maintained at INR intended therapeutic range 2.0-3.0, for a median time of 159 days (range 30-631)total follow-up period 127 patient-years (pt-yrs). Quality of anticoagulation and occurrence of bleeding events were recorded. Patients spent 23%, 64% and 8% of time below, within and above the intended therapeutic range, respectively. When we observed the INR levels, we found that 62 patients (25.6%) had INR>4.5 at least in one occasion, and 23 (9.5%) in ≥ 2. During follow-up, 2 patients had major bleeds (rate 1.6% pt-yrs), one fatal. No embolic complications were recorded. CONCLUSION: Our results show that low-risk AF patients, treated with VKA for elective cardioversion, carry a not irrelevant risk of bleeding. Efforts are required to properly select patients who could benefit from this procedure, reducing the time of warfarin exposure.I documenti in FLORE sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.