Duration of warfarin sodium therapy prior to electrical cardioversion of atrial fibrillation
Duration of warfarin sodium therapy prior to electrical cardioversion of atrial fibrillation
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DOI：
10.1046/j.1365-2796.2003.01084.x
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发表时间：
2003-01-01
影响因子：
11.1
通讯作者：
Rosenqvist, M
中科院分区：
文献类型：
--
作者：
Ryman, J;Frick, M;Rosenqvist, M
目标。评估选择性 DC 心脏复律前华法林钠抗凝治疗的持续时间，并确定预测短期与长期等待时间的临床变量。设计。回顾性。主题。包括已知华法林钠开始使用日期、已知心房颤动 (AF) 持续时间以及接受 DC 心脏复律的患者。主要结果指标。 DC-心脏复律之前华法林钠治疗的持续时间。方法。对斯德哥尔摩两家医院连续 288 名计划进行择期心脏复律的 AF 患者的医院记录进行了审查。研究仅纳入了已知开始服用华法林钠日期和已知 AF 持续时间的患者。结果。中位年龄为 70 (26-85) 岁，心脏复律时 AF 持续时间为 18 周 (5-273) 周。华法林钠复律前的中位治疗时间为 12 周。 224 名患者 (78%) 建立了窦性心律，其中 90 名 (40%) 患者在复律后 1 个月仍保持窦性心律。在多变量分析中，心脏复律等待时间短（8 周与 15 周）的唯一独立预测因素是心脏病专家是否开始使用华法林钠治疗（P < 0.001，95% CI 5.0-9.0）。结论。从开始华法林钠治疗到选择性心脏复律的平均等待时间远远超过了治疗国际标准化比值 (INR) 建议的 3-4 周。为了最大限度地缩短心脏复律之前的时间，必须对院外护理后勤工作进行重大改变。
Objectives. To evaluate the duration of anticoagulation treatment with warfarin sodium before elective DC-cardioversion and to identify clinical variables predicting short-term versus long-term waiting times.Design. Retrospective.Subjects. Patients with a known start date for warfarin sodium, a known duration of atrial fibrillation (AF) and who underwent DC-cardioversion were included.Main outcome measures. Duration of treatment with warfarin sodium prior to DC-cardioversion.Methods. The hospital records of 288 consecutive patients with AF scheduled for elective cardioversion at two hospitals in Stockholm were reviewed. Only patients with a known start date for warfarin sodium and known duration of AF were included in the study.Results. The median age was 70 (26-85) years and the duration of AF at time of cardioversion were 18 weeks (5-273) weeks. The median treatment duration prior to cardioversion with warfarin sodium was 12 weeks. Sinus rhythm was established in 224 (78%) patients of which 90 (40%) remained in sinus rhythm 1 month after cardioversion. In multivariate analysis, the only independent predictor of short waiting times for cardioversion (8 vs. 15 weeks) was if a cardiologist instituted the treatment with warfarin sodium (P < 0.001, 95% CI 5.0-9.0).Conclusion. The average waiting time from start of warfarin sodium treatment to elective cardioversion exceeds by far the recommended 3-4 weeks on therapeutic international normalized ratio (INR). In order to minimize the time period until cardioversion significant changes in the out-of-hospital care logistics has to be undertaken.