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Intensity of anticoagulation and risk of thromboembolism after elective cardioversion of atrial fibrillation

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Date
2017
Author
Hellman Tapio
Kiviniemi Tuomas
Nuotio Ilpo
Vasankari Tuija
Hartikainen Juha
Lip Gregory Y.H.
Airaksinen K.E. Juhani
Unique identifier
10.1016/j.thromres.2017.06.026
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Citation
Hellman Tapio. Kiviniemi Tuomas. Nuotio Ilpo. Vasankari Tuija. Hartikainen Juha. Lip Gregory Y.H.. Airaksinen K.E. Juhani. (2017). Intensity of anticoagulation and risk of thromboembolism after elective cardioversion of atrial fibrillation.  THROMBOSIS RESEARCH, 156, 163-167. 10.1016/j.thromres.2017.06.026.
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© Elsevier Ltd.
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CC BY-NC-ND https://creativecommons.org/licenses/by-nc-nd/4.0/
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 21 days 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.

Subjects
Atrial fibrillation   Stroke   Anticoagulation   Therapeutic range   International normalized rati   
URI
https://erepo.uef.fi/handle/123456789/4395
Link to the original item
http://dx.doi.org/10.1016/j.thromres.2017.06.026
Publisher
Elsevier BV
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