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Outcomes After Cardioversion in Atrial Fibrillation Patients Treated with Non-Vitamin K Antagonist Oral Anticoagulants (NOACs): Insights from a Meta-Analysis

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Abstract

Background

There are limited data on outcomes following cardioversion in atrial fibrillation (AF) patients treated with non-vitamin K antagonist oral anticoagulants (NOACs). A meta-analysis was performed to evaluate the efficacy and safety of NOACs in patients with AF undergoing cardioversion.

Methods

PubMed, Cochrane Library, EMBASE, Web of Science and CINAHL databases were searched from January 1, 2001 through to October 30, 2014. Randomized controlled trials (RCTs) comparing NOACs (apixaban, rivaroxaban and dabigatran) with warfarin in AF patients undergoing cardioversion were selected. The primary efficacy outcome was stroke and systemic embolism, and the primary safety outcome was major or clinically relevant non-major (CRNM) bleeding. We used random-effects models.

Results

Four RCTs were included, involving a total of 3635 randomized participants who underwent a total of 4257 cardioversions. A total of 12 events of stroke and systemic embolism were found in the NOAC group and ten events in the warfarin group [odds ratio (OR) 0.73, 95 % confidence interval (CI) 0.31–1.72]. Risk of major or CRNM bleeding was not different with NOACs, when compared with warfarin (OR 1.41, 95 % CI 0.87–2.28).

Conclusions

Data from patients enrolled in RCTs, showed that NOACs are effective and safe for AF patients undergoing cardioversion.

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Funding sources

No external funds were used in the conduct of this analysis.

Disclosures

Parijat Sen, Amartya Kundu, Partha Sardar, Saurav Chatterjee, Ramez Nairooz, Hossam Amin, and Wilbert Aronow have no conflict that might be relevant to this analysis.

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Authors and Affiliations

  1. Department of Medicine, St. Michael’s Medical Center, Newark, NJ, USA

    Parijat Sen

  2. Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA

    Amartya Kundu

  3. Department of Cardiology, University of Utah, Salt Lake City, Utah, USA

    Partha Sardar

  4. St Luke’s Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, NY, USA

    Saurav Chatterjee

  5. Department of Cardiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA

    Ramez Nairooz

  6. Department of Medicine, New York Medical College-Metropolitan Hospital Center, New York, NY, USA

    Hossam Amin

  7. Division of Cardiology, New York Medical College, Valhalla, NY, USA

    Wilbert S. Aronow

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Correspondence to Parijat Sen.

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Sen, P., Kundu, A., Sardar, P. et al. Outcomes After Cardioversion in Atrial Fibrillation Patients Treated with Non-Vitamin K Antagonist Oral Anticoagulants (NOACs): Insights from a Meta-Analysis. Am J Cardiovasc Drugs 16, 33–41 (2016). https://doi.org/10.1007/s40256-015-0136-1

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