doyoudig
Forum Guru
Topics: 144
Posts: 613
|
Can somone pls calrify to the following
A Pt w/ stable chronic Afib is considered for chemical cardioversion, so we put the pt on anticoagulation for 3-4 wks before cardiove (what do you use.. IV or (Oral) Heparin for a few days then add warfarin???)
I am confused about when to use or add warfarin?????
How about the same scenarion but npw Pt has Stable ACUTE Afib and is considered for cardioversion to convert to sinus rhtym???
thx in advance
|
| doyoudig
Forum Guru
Topics: 144
Posts: 613
|
but doc, u are never suppose to cardiovert chemically or electrically in stable Pt w/ Afib
they need anticoagulation 1st, am I correct?
The question is what type of anticoagulation in
--> Acute before and After Cradioversion
--> Chronic Afib before and after Anticoagulation
Is it IV heparin in stable but acute situation the ardiovert than put Pt on heparin again + warfarin or just heaprin or warfarin?
How about chronic stabe Afib when u want to convert to sinus rhtym?
|
| arlete
Half way there!
Topics: 44
Posts: 3,108
|
Guys, when did low molecular weight heparin substituted warfarin for anticoagulation in AFib patients?
(I am not being ironic, it's just that that it must be a very recent development that I did not hear about...)
Any patient with history sugestive of more then 48 h of AFib needs to be anticoagulated for 3-4 weeks before cardioversion, unless hemodinamically unstable. But to be quite sincere, when the patients arrive unstable, the cardiac rate is so high that they probably have a very recent onset arrhythmia, not a big chance they have a thrombi formed.
___________________
Que sera sera, whatever will be will be.
|
| dr in trouble
Forum Guru
Topics: 62
Posts: 610
|
Sorry guys about the LMWH info but here is what I found
Heparin is the preferred agent for initial anticoagulation because it provides almost immediate effects and can be discontinued rapidly if bleeding complications arise.5 The drug should be given as a continuous intravenous infusion, with the dose titrated to achieve an activated partial thromboplastin time of 1.5 to 2.5 times the baseline value.
In patients with atrial fibrillation that has persisted for more than 48 hours, heparin can be used to reduce the risk of thrombus formation and embolization until the warfarin level is therapeutic or cardioversion is performed. Prevention of deep venous thrombosis and pulmonary embolism are potential added benefits of initial anticoagulation with heparin. Warfarin should be given for three weeks before elective electrical cardioversion and continued for four weeks after successful cardioversion.
Low-molecular-weight heparins such as enoxaparin (Lovenox) and dalteparin (Fragmin) have not been studied extensively in patients with atrial fibrillation. However, low-molecular-weight heparin are easier to use than standard unfractionated heparin, and anticoagulation with these agents may facilitate early hospital discharge. Studies are currently being performed to evaluate anticoagulation with low-molecular-weight heparins before and after cardioversion in patients with atrial fibrillation
___________________
If u want to do something, do it today as there is no tomorrow.
|
| dr in trouble
Forum Guru
Topics: 62
Posts: 610
|
Anticoagulation During Cardioversion
EARLY CARDIOVERSION
Early medical or electrical cardioversion may be instituted without prior anticoagulation therapy when atrial fibrillation has been present for less than 48 hours. No specific data suggest significant benefit for heparin therapy in the first 48 hours of atrial fibrillation; however, heparin is routinely used.
If the duration of atrial fibrillation exceeds 48 hours or is unknown, transesophageal echocardiography (to rule out atrial thrombi) followed by early cardioversion is a clinically effective strategy. Heparin therapy should be instituted during transesophageal echocardiography. If no atrial thrombi are observed, cardioversion can be performed. If atrial thrombi are detected, cardioversion should be delayed and anticoagulation continued. To decrease the risk of thrombus extension, heparin should be continued, and warfarin therapy should be initiated. Once the INR is above 2.0, heparin can be discontinued, but warfarin should be continued for four weeks .If cardioversion is unsuccessful and patients remain in atrial fibrillation, warfarin or aspirin may be considered for long-term prevention of stroke.
ELECTIVE CARDIOVERSION
Warfarin should be given for three weeks before elective electrical cardioversion is performed. After successful cardioversion, warfarin should be continued for four weeks to decrease the risk of new thrombus formation.Alternative approaches using low-molecular-weight heparins are under investigation.If atrial fibrillation recurs or patients are at high risk for recurrent atrial fibrillation, warfarin may be continued indefinitely, or aspirin therapy may be considered.
Attached Files:
A FIB.doc (35 KB, 5 downloads)
Edited by dr in trouble on 06/28/07 - 10:15 PM. Reason: add more info
___________________
If u want to do something, do it today as there is no tomorrow.
|
|
| |
| | | | | |
