Daily Archive 18.02.2019

Anticoagulants before and after cardioversion of atrial fibrillation

Cardioversion can lead to immediate systemic embolism due to fragmentation of a blood clot that already exists in L. P. In addition, new blood clots can form after cardioversion, since recovery of the mechanical function of the atria often does not complete until 3 weeks. after the procedure, and also because cardioversion itself can cause hypercoagulation.

Thus, thromboembolic complications can occur within a few weeks after cardioversion. Therefore, it is important that planned cardioversion in patients with AF, which lasts more than 24-48 hours, is preceded by taking warfarin with retention of an MHO value of 2.5 for at least 3 weeks. and that the use of anticoagulants lasts for at least 4 weeks. after restoring rhythm. The deterioration of the mechanical function of the atria (denoted by the term “stunning”) is also noted after pharmacological cardioversion.

If emergency cardioversion is required, a transesophageal echocardiography can be performed to rule out thrombosis or blood stasis in the LP. If cardioversion is performed on an emergency basis, it should be preceded by the appointment of heparin, followed by the continuation of its introduction and the appointment of warfarin. It was shown that dabigatran is as effective as warfarin in preventing stroke associated with cardioversion.