Poor anticoagulation relates to extended access times for cardioversion and is associated with long-term major cardiac and cerebrovascular events

Ömer Erküner*, Roy Claessen, Ron Pisters, Germaine Schulmer, Roos Ramaekers, Laura Sonneveld, Elton Dudink, Theo Lankveld, Ione Limantoro, Bob Weijs, Laurent Pison, Yuri Blaauw, Cees B. De Vos, Harry J. G. M. Crijns

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Background: Patients undergoing elective electrical cardioversion (ECV) for atrial fibrillation have a temporarily increased risk of thromboembolism. Current guidelines recommend adequate anticoagulation for >= 3 consecutive weeks precardioversion, i.e. consecutive INR values 2.0-3.0 in patients with vitamin K antagonists (VKA). We aimed to evaluate the occurrence and impact of subtherapeutic INRs precardioversion and to study factors associated with these unwanted fluctuations. Methods: We recruited 346 consecutive patients undergoing elective ECV in the Maastricht University Medical Centre between 2008 and 2013. Predictors of subtherapeutic INR values were identified and incorporated into a logistic regression model. Results: A subtherapeutic INR precardioversion occurred in 55.2% of patients. The only statistically significant predictor was VKA-naivety (Odds Ratio (OR) 4.78, 95% Confidence Interval (CI) 2.67-8.58, p <0.001). In patients with >= 1 subtherapeutic INR precardioversion, time from referral until cardioversion was 91.1 +/- 42.8 days, compared to 41.7 +/- 26.6 days (p <0.001) in patients without subtherapeutic INRs. No thromboembolic events occurred
Original languageEnglish
Pages (from-to)337-341
JournalInternational Journal of Cardiology
Publication statusPublished - 15 Dec 2016


  • Atrial fibrillation
  • Cardioversion
  • Vitamin K antagonist
  • Anticoagulation management

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