‘Syringe-in-the-Pocket’ – A New Approach to the Outpatient Thromboembolic Prophylaxis of Recurrent Atrial Fibrillation

Abstract

Chronic anti-coagulation is not an attractive prospect to patients with atrial fibrillation (AF) after successful restoration of sinus rhythm. We researched the feasibility of self-screening for AF performed by instructed patients and, where necessary, prompt self-administration of an initial dose of low-molecular weight heparin (LMWH) prior to seeking medical attention. Materials and Methods: Persistent AF qualified to elective cardioversion was our focus. Two hundred and sixty-three consecutive patients (M/F: 179/84, mean age: 59.8 ± 8.6) were followed for a mean of 2.6 ± 1.7 years. All patients were trained to identify AF by palpation of the radial pulse and to self-inject LMWH in the case of arrhythmia recurrence. Two hundred and thirty-two patients who correctly recognized AF recurrence and those without episodes of AF during 4 weeks after cardioversion were equipped with nadroparine after acenocoumarol discontinuation. In 191 patients AF recurred during further observation, 172 of them correctly identified AF episodes, including 162 who performed LMWH injections at home. Seven patients who had performed LMWH injections presented with sinus rhythm on arrival to hospital, six patients had AF. Two out of 21 patients who failed to identify their AF episodes and one patient of those who correctly detected the AF recurrence, but failed to perform LMWH self-injection suffered from ischemic stroke (sensitivity 96.1%, specificity 60.4%). No side effects of domiciliary LMWH self-injection were identified. Conclusion: When properly trained, the majority of patients can accurately diagnose AF recurrence and self-inject an initial dose of LMWH, which makes it a feasible and potentially attractive anti-thromboembolic strategy.