PHYSICIAN PRACTICES REGARDING ANTICOAGULATION AND CARDIOVERSION OF ATRIAL-FIBRILLATION

Background: Stroke is one of the most significant potential complicati ons in patients who are undergoing cardioversion for atrial fibrillati on. To minimize the risk of stroke, the American College of Chest Phys icians' (ACCP's) Third Consensus Conference on Antithrombotic Therapy developed specific recommendations regarding anticoagulation before an d following elective cardioversion of patients with atrial fibrillatio n. Objective: To determine if patients undergoing cardioversion for at rial fibrillation are administered anticoagulants according to the ACC P's Third Consensus Conference on Antithrombotic Therapy recommendatio ns. Design: A retrospective review of cases of atrial fibrillation at a tertiary care teaching hospital to determine ii physicians are routi nely following these recommendations. Methods: Data were collected for the year 1994 for all patients admitted to a tertiary care teaching h ospital with a diagnosis of atrial fibrillation (n=111). The AC CP's r ecommendations that were evaluated included the following: patients un dergoing elective cardioversion for atrial fibrillation should receive anticoagulation for 3 weeks before and 4 weeks following cardioversio n except in cases of new-onset atrial fibrillation, and warfarin and h eparin should be administered jointly far several days before disconti nuation of heparin therapy. Results: Of the 111 patients who presented with a diagnosis of atrial fibrillation, 51 underwent elective cardio version. In 18 (35%) of 51 cases, physicians failed to follow at least one of ACCP's recommendations regarding anticoagulation. These includ ed failing to (1) administer anticoagulants to patients for 3 weeks be fore elective cardioversion (n=14); (2) administer anticoagulants to p atients for 4 weeks following cardioversion (n=6); and (3) overlap hep arin and/or warfarin therapies for 72 hours (n=4). Six cases failed to meet more than one of these recommendations. Conclusion: Physicians a re not routinely following the ACCP's Third Consensus Conference on An tithrombotic Therapy recommendations regarding anticoagulation in elec tive cardioversion of atrial fibrillation, thus increasing patients' r isk of stroke.