The majority of patients who are going to ovulate will do so after the first course of therapy. If ovulation does not occur after three courses of therapy, further treatment with Clomid is not recommended and the patient should be reevaluated. If three ovulatory responses occur, but pregnancy has not been achieved, further treatment is not recommended. If menses does not occur after an ovulatory response, the patient should be reevaluated. Long-term cyclic therapy is not recommended beyond a total of about six cycles (see PRECAUTIONS ).
In hemodynamically compromised patients, AF must be treated emergently with synchronized electric cardioversion. There are no controlled studies available to suggest recommendations regarding anticoagulation in these patients. In a nonrandomized trial of 437 patients (532 instances of cardioversion), 20 the incidence of an embolic event was percent in the group receiving anticoagulant therapy, compared with percent in the group not receiving anticoagulant therapy. These results are impressive because the number of patients with congestive heart failure, hypertension and rheumatic heart disease was greater in the anticoagulation group than in the group not receiving anticoagulation.