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Dabigatran, electrical cardioversion and measuring the aPTT. A safety measure or an unnecessary assessment?

N Rahmat1, A Khan

  • 1Department of Cardiology, Ipswich Hospital, Suffolk, Ipswich, UK. avi.rahmat@yahoo.co.uk

BMJ Case Reports
|June 21, 2013
PubMed

Insights

Two patients on dabigatran for stroke prevention required electrical cardioversion. Measuring activated partial thromboplastin time (aPTT) before cardioversion revealed varying anticoagulant levels, complicating the procedure.

Area of Science:

  • Cardiology
  • Pharmacology

Background:

  • Non-valvular atrial fibrillation (NVAF) necessitates anticoagulation for stroke prevention.
  • Dabigatran is an oral anticoagulant used for stroke risk reduction in NVAF.
  • Direct current electrical cardioversion (DCCV) is a procedure to restore normal heart rhythm.

Observation:

  • Two cases of NVAF patients on dabigatran therapy were scheduled for DCCV.
  • Activated partial thromboplastin time (aPTT) was measured pre-DCCV to assess dabigatran's anticoagulant effect.
  • aPTT measurements yielded different results, impacting procedural planning.

Findings:

  • The utility of aPTT for monitoring dabigatran's anticoagulant activity prior to DCCV can be variable.
  • aPTT results influenced the management decisions in these otherwise routine cases.
  • Standardized monitoring protocols for direct oral anticoagulants like dabigatran during cardioversion may be needed.

Implications:

  • These cases highlight potential challenges in managing patients on dabigatran undergoing DCCV.
  • Further research is warranted to establish optimal protocols for anticoagulant monitoring during cardioversion.
  • Clinicians should be aware of the potential variability in aPTT measurements when assessing dabigatran's effect.

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