The Pharmaceutical Journal
Vol 269 No 7215 p355
14 September 2002

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European Society of Cardiology (www.escardio.org)

New heparins better for patients with atrial fibrillation, but blood pressure is also an important factor

Low molecular weight heparin is preferable to conventional anticoagulation therapy in electrical cardioversion (ECV) of atrial fibrillation (AF) patients, according to clinical trial results. Meanwhile, a second study says blood pressure should be a deciding factor for whether to use ECV or rate control drugs.

Data from the ACE (anticoagulation for cardioversion using enoxaparin) trial show that embolism, major bleeds or death occurred in 3.2 per cent of ECV patients given enoxaparin (Clexane) subcutaneously, compared with 5.7 per cent of those treated conventionally, with a combination of intravenous heparin followed by phenprocoumon.

The German researchers say this is the first study to show enoxaparin is at least as effective as the standard heparin and phenprocoumon approach. They add that low molecular weight heparins are advantageous because they can be given subcutaneously, thus allowing therapy initiation in outpatient clinics. In addition, because low molecular weight heparins rapidly provide a stable level of anticoagulation, they reduce the need for frequent blood sampling.

But Dutch researchers found the incidence of cardiovascular events and death was 23.8 per cent lower in AF patients treated with rate control drugs, such as digitalis, rather than ECV. The incidence of events was 17.2 per cent among those on rate control drugs and 22.6 per cent among those given ECV. An analysis of outcomes data based on whether patients had high or low blood pressure, showed that 30.8 per cent of those with high blood pressure, who were given ECV, suffered cardiovascular events, compared with 17.3 per cent of those with high blood pressure treated with rate control drugs. The researchers say that high blood pressure, which occurs in over half of all AF patients, could be associated with an increased risk of such events among patients managed by ECV. They conclude that aggressive rhythm control with ECV is not better than straightforward rate control: "[It] suggests ECV may be avoided in most patients with persistent AF."

The data were presented at the European Society of Cardiology congress in Berlin earlier this month.