Value of Trans-oesophageal Echocardiography As a Method of Encouraging Patients with Chronic Atrial Fibrillation to Use Anticoagulation Therapy

Overview

Journal Cardiovasc J Afr

Specialty Cardiology & Vascular Diseases

Date 2010 Sep 15

PMID 20838716

Authors

A Bakalli

L Kamberi

G Dragusha

N Zeqiri

F Gashi

L Prekpalaj

Affiliations

Soon will be listed here.

Abstract

Background: Despite the indisputable role of anticoagulation therapy for atrial fibrillation (AF) patients at risk for stroke, anticoagulants remain under-used in everyday clinical practice. We assumed that by performing trans-oesophageal echocardiography (TEE) on patients with AF who were not on anticoagulation treatment prior to the procedure, and by explaining to them the TEE images obtained, as well as the possible consequences of these findings, we could convince patients to start anticoagulation therapy. The main objective of the study was to assess the examined patients' adherence to warfarin therapy over a two-year period.

Methods And Results: We conducted a prospective TEE study from February 2006 to December 2008 on 70 patients with chronic AF who were not on anticoagulation treatment. Mean patient age was 65.85 ± 10.02 years and 68.57% were women. Thrombus in the left atrial appendage was found in 25 (35.71%) patients. Fifty-four (77.14%) patients had thrombi or spontaneous echo contrast in at least one of their supraventricular cavities. Following the procedure and with detailed explanation to the patients of their TEE findings, we managed to start anticoagulation therapy on 60 (85.71%) patients. At the end of the follow-up period of 23.76 ± 2.8 months, 53 (75.71%) patients remained on warfarin therapy. The rest of the surviving patients settled for thrombo-prophylaxis with aspirin.

Conclusion: TEE is a valuable method that, in addition to its diagnostic possibilities, could also serve as a convincing visual method of putting atrial fibrillation patients onto an anticoagulation regimen.

References

Perez I, Melbourn A, Kalra L . Use of antithrombotic measures for stroke prevention in atrial fibrillation. Heart. 1999; 82(5):570-4. PMC: 1760775. DOI: 10.1136/hrt.82.5.570. View

Fuller R, Dudley N, Blacktop J . Risk communication and older people-understanding of probability and risk information by medical inpatients aged 75 years and older. Age Ageing. 2001; 30(6):473-6. DOI: 10.1093/ageing/30.6.473. View

Howitt A, Armstrong D . Implementing evidence based medicine in general practice: audit and qualitative study of antithrombotic treatment for atrial fibrillation. BMJ. 1999; 318(7194):1324-7. PMC: 27873. DOI: 10.1136/bmj.318.7194.1324. View

Fuller R, Dudley N, Blacktop J . Avoidance hierarchies and preferences for anticoagulation--semi-qualitative analysis of older patients' views about stroke prevention and the use of warfarin. Age Ageing. 2004; 33(6):608-11. DOI: 10.1093/ageing/afh202. View

Sudlow M, Thomson R, Thwaites B, Rodgers H, Kenny R . Prevalence of atrial fibrillation and eligibility for anticoagulants in the community. Lancet. 1998; 352(9135):1167-71. DOI: 10.1016/S0140-6736(98)01401-9. View

Iqbal M, Taneja A, Lip G, Flather M . Recent developments in atrial fibrillation. BMJ. 2005; 330(7485):238-43. PMC: 546076. DOI: 10.1136/bmj.330.7485.238. View

Kutner M, Nixon G, SILVERSTONE F . Physicians' attitudes toward oral anticoagulants and antiplatelet agents for stroke prevention in elderly patients with atrial fibrillation. Arch Intern Med. 1991; 151(10):1950-3. View

Wolf P, Abbott R, Kannel W . Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. Stroke. 1991; 22(8):983-8. DOI: 10.1161/01.str.22.8.983. View

Lip G, Kamath S, Jafri M, Mohammed A, Bareford D . Ethnic differences in patient perceptions of atrial fibrillation and anticoagulation therapy: the West Birmingham Atrial Fibrillation Project. Stroke. 2002; 33(1):238-42. DOI: 10.1161/hs0102.101817. View

10.

Lip G, Zarifis J, Watson R, Beevers D . Physician variation in the management of patients with atrial fibrillation. Heart. 1996; 75(2):200-5. PMC: 484261. DOI: 10.1136/hrt.75.2.200. View

11.

Manning W, Silverman D, Waksmonski C, Oettgen P, Douglas P . Prevalence of residual left atrial thrombi among patients with acute thromboembolism and newly recognized atrial fibrillation. Arch Intern Med. 1995; 155(20):2193-8. View

12.

Hart R, Pearce L, Aguilar M . Meta-analysis: antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation. Ann Intern Med. 2007; 146(12):857-67. DOI: 10.7326/0003-4819-146-12-200706190-00007. View

13.

Stafford R, Singer D . National patterns of warfarin use in atrial fibrillation. Arch Intern Med. 1996; 156(22):2537-41. View

14.

Hart R, Benavente O, McBride R, Pearce L . Antithrombotic therapy to prevent stroke in patients with atrial fibrillation: a meta-analysis. Ann Intern Med. 1999; 131(7):492-501. DOI: 10.7326/0003-4819-131-7-199910050-00003. View

15.

Brass L, Krumholz H, Scinto J, Radford M . Warfarin use among patients with atrial fibrillation. Stroke. 1997; 28(12):2382-9. DOI: 10.1161/01.str.28.12.2382. View