Low molecular weight heparin in atrial fibrillation management: facts, fiction, future.

BACKGROUND: Atrial fibrillation (AF) is the most common sustained arrhythmia and various AF disease management strategies can be utilized. METHODS: A prospective, randomized pilot study of two AF disease management strategies was conducted at a single university hospital in patients newly diagnosed with AF. The impact of low molecular weight heparin (LMWH) on AF management strategies is discussed with respect to the current guidelines for AF management, existing data on LMWH for AF, and recent investigations pertaining to AF. RESULTS: 18 patients were enrolled. The accelerated emergency department based strategy utilizing LMWH resulted in a significant reduction in length of stay (2.1 +/- 2.3 versus <1 day) and a trend toward lower costs (1,706 +/- 1,512 dollars versus 879 +/- 394 dollars; p = 0.15) when compared to the more traditional strategy of hospital admission. Measured clinical outcomes were similar for both treatment strategies. CONCLUSIONS: The investigation showed that an outpatient, emergency department based disease management strategy for new, uncomplicated AF could result in clinically acceptable, cost-effective innovations in AF treatment strategies. LMWH is an example of an agent allowing innovations in disease management strategies.