RT-142
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Electric cardioversion of atrial
fibrillation: anticoagulant prophylaxis with calcic and sodic heparin and dicoumarolics
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Mauro Giuliani, Ruggero Cabri,
Francesco Marzani, Mariano Capitelli, Roberto Salati.
Unita Operativa di Medicina Interna, Modulo di Cardiologia, Ospedale di Pavullo,
Modena, Italy
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Abstract
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Aims of the study. To evaluate the
efficacy, in the prevention of the embolic risk of electric cardioversion (ECV) of atrial
fibrillation (AF), of calcic and sodic heparin, compared to the more consolidated
treatment, more unpleasant for pts, of prolonged treatment with dicumarol per os.
Materials and methods. A hundred and thirteen pts, with average age
64 ± 13 years, 59 of them M, with AF from 4 to 90 days showing no response to
pharmacological therapy and treated with ECV (200-300-360 Joules), were randomized into 3
groups on the basis of the prophylactic anticoagulant therapy used:
Group A: 38 pts treated with dicumarol per os 3 weeks before and 4 weeks after ECV;
Group B: 37 pts treated with sodic heparin intravenously for 24 hours;
Group C: 37 pts treated with calcic heparin 12 500 U every 8 hours 3 days before and
after ECV.
A transthoracic and/or transaesophageous echocardiogram was performed on all pts, with
PTT at least once a day to check that there was an increase of at least 1.5-2.5 compared
to the basal value.
Results. After ECV the sinus rhythm (SR) was restored in 99 of the
113 pts (87.6%) and maintained at 6 months in 78/99 pts (78.7%). In 86/99 pts (86.8%) the
SR was obtained with the first Dc-shock at 200 Joules. No emboli occurred in any of the
three groups during the 6 months of follow-up. However, there were 3 minor haemorrhages in
the pts treated with dicumarol per os and 2 in the pts treated with intravenous sodic
heparin.
Conclusions. For the ECV procedure, anticoagulant prophylaxis with
subcutaneous calcic heparin and continuous infusion of sodic heparin is effective and
safe; it reduces hospitalization times, inconvenience for pts and costs.
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Key Words
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Atrial fibrillation – thromboembolic
events
anticoagulation therapy, calcic and sodium heparin, dicoumarol, transoesophageal
echocardiography, ACUTE trial, OA
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