Efficacy and Safety of Non vitamin K Antagonist Oral Anticoagulants after Cardioversion for Non-valvular Atrial Fibrillation.
Am J Med. 2016 Jun 1;
Authors: Renda G, Zimarino M, Ricci F, Piccini JP, Ezekowitz MD, Patel MR, Cappato R, Giugliano RP, De Caterina R
BACKGROUND: Non vitamin K oral anticoagulants (NOACs) are proven alternatives to vitamin K antagonists (VKAs) for the prevention of thromboembolism in patients with non-valvular atrial fibrillation. However, there are few data on the efficacy and safety of NOAC therapy after cardioversion, where the risk of thromboembolic events is heightened.
METHODS: We performed a random-effects meta-analysis of patients who underwent both electrical and pharmacological cardioversion for atrial fibrillation in the RE-LY, ROCKET-AF, ARISTOTLE, ENGAGE AF-TIMI 48 and X-VeRT trials. We assessed Mantel-Haenszel pooled estimates of relative risk (RR) and 95% confidence intervals (CIs) for stroke/systemic embolism and major bleeding at ≤42 days of follow-up.
RESULTS: The analysis pooled 3,949 patients in whom a total of 4,900 cardioversions for atrial fibrillation were performed. Compared with VKAs, NOAC therapy was associated with a similar risk of stroke/systemic embolism (RR=0.84; 95% CI: 0.34-2.04) and major bleeding (RR=1.12; 95% CI: 0.52-2.42); no significant statistical heterogeneity was found among studies (Cochrane Q P=0.59, I(2)=0% for stroke/systemic embolism; P=0.47; I(2)= 0% for major bleeding).
CONCLUSIONS: The short-term incidences of thromboembolic and major hemorrhagic events after cardioversion on NOACs were low and comparable with those observed on dose-adjusted VKA therapy. NOACs are a reasonable alternative to VKAs in patients undergoing cardioversion.
PMID: 27262782 [PubMed - as supplied by publisher]