Evaluation of Peri-procedural Warfarin Therapy Undergoing Cardioversion in Patients with Atrial fibrillation

OBJECTIVE: Direct current cardioversion for atrial fibrillation could be associated with the risk of thromboembolic events. Anticoagulation therapy with warfarin (INR 2.0-3.0) is recommended 3 weeks before and 4 weeks after cardioversion to reduce the risk of thromboembolism. This study evaluated warfarin therapy in pharmacist-managed anticoagulant services (ACS). METHODS: This retrospective study was performed in 106 patients with atrial fibrillation from 2012 to 2013. The primary efficacy endpoint was the composite of stroke, transient ischemic attack, myocardial infarction, and cardiovascular death. The primary safety measure was major bleeding. To evaluate the peri-procedural effects of warfarin treatment, we studied whether target INR was maintained, as well as the maintenance period of the therapeutic range. Quality of treatment was measured by time in therapeutic range (TTR) by using the Rosendaal method. RESULTS: There were no thromboembolic events, but TEE examination at time of cardioversion showed a left atrial thrombus in three patients (2.8%). Bleeding complications after cardioversion occurred in 2 patients (1.9%). The average INR value at the time of cardioversion was 2.59±0.8, and was within the therapeutic range in 83 patients (78%). Analysis of the patients in whom the value was within the therapeutic range twice consecutively showed that the ratio of TTR was 80% and the therapeutic range was maintained in 67 patients (63%) for an average of 4.90 weeks prior to cardioversion. Similarly, 76 patients (72%) had a stable INR within the therapeutic range for an average of 5.70 weeks and a mean TTR of 83%. CONCLUSION: Pharmacists significantly contributed to appropriate warfarin treatment with close monitoring during cardioversion. Likewise, active pharmacist monitoring and systemic management should be considered to reduce thromboembolism and bleeding complications in the peri-cardioversion period.

Observation of the effect of pretreatment with ibutilide and direct current on cardioversion of patients with persistent atrial fibrillation and the peri-treatment care / 中国实用护理杂志

ObjectiveTo investigate the success rate and energy requirements of ibutilide and direct current(DC)cardioversion,summarize the nursing experience.MethodsForty-six patients with persistent atrial fibrillation were enrolled and underwent DC cardioversion were selelct from May 2009 to January 2011.23 patients received pretreatment with ibutilide before DC (the ibutilide group),23 patients received non drugs before DC (the control group).The cardioversion energy started at 100 J and increased if patients could not acquire sinus rhythm.All the patients were given pertinent care before,during and posttreatment.The success rate and energy requirements of the two groups were compared.Results95.7％ of the patients were successfully cardioverted in the ibutilide group,which was significantly higher than 74.0％ of the control group.The energy required for cardioversion was ( 139.1±45.1 ) J in the ibutilide group,significantly lower than (197.8±53.3) J in the control group.Non patients terminated treatment or appeared complication because of improper nursing.ConclusionsPretreatment with ibutilide enhanced the efficacy of DC cardioversion for the patients with persistent AF at lower energy requirements.Proper nursing care can ensure the smooth process of treatment and decrease the complications.