Abstract
Recent trials on novel oral anticoagulants (NOAC) in patients undergoing cardioversion showed that NOACs are as safe and effective as treatment with vitamin K antagonists in patients with atrial fibrillation undergoing electric or pharmacological cardioversion. We conducted an EMBASE and MEDLINE search for studies in which patients undergoing cardioversion were assigned to treatment with NOACs versus VKAs. We identified one prospective randomized study and three post hoc analysis of randomized trials which enrolled 2,788 controls that received NOACs and 1,729 patients that received VKAs. NOACs and VKAs had comparable effects on the rates of stroke/thromboembolism, major bleeding events and all-cause mortality. NOACs are safe and effective alternatives to VKA in patients with AF undergoing cardioversion.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Klein AL, Grimm RA, Murray RD, Apperson-Hansen C, Asinger RW, Black IW, Davidoff R et al (2001) Assessment of cardioversion using transesophageal echocardiography investigators. use of transesophageal echocardiography to guide cardioversion in patients with atrial fibrillation. N Engl J Med 344:1411–1420
January CT, Wann LS, Alpert JS, Calkins H, Cleveland JC Jr, Cigarroa JE, Conti JB et al (2014) AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the Heart Rhythm Society. J Am Coll Cardiol. doi:10.1016/j.jacc.2014.03.022
Nagarakanti R, Ezekowitz MD, Oldgren J, Yang S, Chernick M, Aikens TH, Flaker G et al (2011) Dabigatran versus warfarin in patients with atrial fibrillation: an analysis of patients undergoing cardioversion. Circulation 123:131–136
Piccini JP, Stevens SR, Lokhnygina Y, Patel MR, Halperin JL, Singer DE, Hankey GJ et al (2013) Outcomes following cardioversion and atrial fibrillation ablation in patients treated with rivaroxaban and warfarin in the ROCKET AF trial. J Am Coll Cardiol 61:1998–2006
Flaker G, Lopes RD, Al Khatib SM, Hermosillo AG, Hohnloser SH, Tinga B, Zhu J et al (2014) Efficacy and safety of apixaban in patients after cardioversion for atrial fibrillation: insights from the ARISTOTLE trial (apixaban for reduction in stroke and other thromboembolic events in atrial fibrillation). J Am Coll Cardiol 63:1082–1087
Cappato R, Ezekowitz MD, Klein AL, Camm AJ, Ma CS, Le Heuzey JY, Talajic M et al (2014). On behalf of the X-VeRT investigators. Rivaroxaban versus vitamin K antagonists for cardioversion in atrial fibrillation. Eur Heart J. (In press)
Higgins JP, Altman DG, Gotzsche PC, Cochrane bias Methods Group, Cochrane Statistical Methods Group (2011) The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ 343:d5928
Arnold AZ, Mick MJ, Mazurek RP, Loop FD, Trohman RG (1992) Role of prophylactic anticoagulation for direct current cardioversion in patients with atrial fibrillation or atrial flutter. J Am Coll Cardiol 19(4):851–855
Grimm RA, Stewart WJ, Maloney JD, Cohen GI, Pearce GL, Salcedo EE, Klein AL (1993) Impact of electrical cardioversion for atrial fibrillation on left atrial appendage function and spontaneous echo contrast: characterization by simultaneous transesophageal echocardiography. J Am Coll Cardiol 22(5):1359–1366
Conflict of interest
No conflicts of interest declared.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Briasoulis, A., Kottam, A., Khan, M. et al. Novel oral anticoagulants in patients undergoing cardioversion for atrial fibrillation. J Thromb Thrombolysis 40, 139–143 (2015). https://doi.org/10.1007/s11239-014-1161-7
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11239-014-1161-7