Atrial Fibrillation ADP - Part 1 - Cardioversion

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James M., D.O. -

Great discussion! In our ED the practice lately has been to administer a dose of apixiban one to two hours prior to cardioversion followed by a course of apixiban for 30 days.

Sean D. -

To determine time of onset do you just take the patient's word for it? Is there concern that the afib could have started before the patient reported symptoms thereby increasing thromboemoblic events if over 48 hours?

Rob O -

Hi Sean,
That is a great question and an area of (relative) consternation. To your point, yes, you are taking the patient's word for it, but the onset of symptoms needs to be clear cut. If there is any doubt, any "maybe it started around this time," then I do not take that as a clear time of onset and consider it indeterminate.

Rob O -

Hi Sean,
That is a great question and an area of (relative) consternation. To your point, yes, you are taking the patient's word for it, but the onset of symptoms needs to be clear cut. If there is any doubt, any "maybe it started around this time," then I do not take that as a clear time of onset and consider it indeterminate.

brendan c., m.d. -

I would definitely obtain labs in those patients where a chemical cardioversion is considered. Corvert has about a 4% rate of VT which is probably more likely in a hypo-k or hypo-mag patient. I always check labs and QT before I consider chemical cardioversion. The ADP seems like standard ED practice but to formalize it any most hospitals would require labs as part of the process.

Brian D., DO -

would aspirin be considered good enough for anticoagulation? seems less risky that a 10A inhibitor

Rob O -

Hi Brian,
What context are you referring to? For chronic a-fib, much of it depends on the CHADS2-VASC score, risk for stroke, risk for bleeding (HAS-BLED) score, and shared decision making with the patient. Aspirin is for low risk, anticoagulation is for higher (and not necessarily high) risk.

fahad A. -

ADP abreviation of what ?

Mike -

Accelerated Diagnostic Pathway

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