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Efficacy and Safety of Non-Vitamin K Antagonist Oral Anticoagulants After Cardioversion for Nonvalvular Atrial Fibrillation.

Publication ,  Journal Article
Renda, G; Zimarino, M; Ricci, F; Piccini, JP; Ezekowitz, MD; Patel, MR; Cappato, R; Giugliano, RP; De Caterina, R
Published in: Am J Med
October 2016

BACKGROUND: Non-vitamin K oral anticoagulants (NOACs) are proven alternatives to vitamin K antagonists (VKAs) for the prevention of thromboembolism in patients with nonvalvular 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 pharmacologic 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 risk ratio (RR) and 95% confidence intervals (CIs) for stroke/systemic embolism and major bleeding at ≤42 days of follow-up. RESULTS: The analysis pooled 3949 patients in whom a total of 4900 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 = .59, I(2) = 0% for stroke/systemic embolism; P = .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 to those observed on dose-adjusted VKA therapy. Non-vitamin K oral anticoagulants are a reasonable alternative to VKAs in patients undergoing cardioversion.

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Published In

Am J Med

DOI

EISSN

1555-7162

Publication Date

October 2016

Volume

129

Issue

10

Start / End Page

1117 / 1123.e2

Location

United States

Related Subject Headings

  • Warfarin
  • Treatment Outcome
  • Thromboembolism
  • Stroke
  • Rivaroxaban
  • Pyridones
  • Pyrazoles
  • Odds Ratio
  • Humans
  • Hemorrhage
 

Citation

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Renda, G., Zimarino, M., Ricci, F., Piccini, J. P., Ezekowitz, M. D., Patel, M. R., … De Caterina, R. (2016). Efficacy and Safety of Non-Vitamin K Antagonist Oral Anticoagulants After Cardioversion for Nonvalvular Atrial Fibrillation. Am J Med, 129(10), 1117-1123.e2. https://doi.org/10.1016/j.amjmed.2016.05.007
Renda, Giulia, Marco Zimarino, Fabrizio Ricci, Jonathan P. Piccini, Michael D. Ezekowitz, Manesh R. Patel, Riccardo Cappato, Robert P. Giugliano, and Raffaele De Caterina. “Efficacy and Safety of Non-Vitamin K Antagonist Oral Anticoagulants After Cardioversion for Nonvalvular Atrial Fibrillation.Am J Med 129, no. 10 (October 2016): 1117-1123.e2. https://doi.org/10.1016/j.amjmed.2016.05.007.
Renda G, Zimarino M, Ricci F, Piccini JP, Ezekowitz MD, Patel MR, et al. Efficacy and Safety of Non-Vitamin K Antagonist Oral Anticoagulants After Cardioversion for Nonvalvular Atrial Fibrillation. Am J Med. 2016 Oct;129(10):1117-1123.e2.
Renda, Giulia, et al. “Efficacy and Safety of Non-Vitamin K Antagonist Oral Anticoagulants After Cardioversion for Nonvalvular Atrial Fibrillation.Am J Med, vol. 129, no. 10, Oct. 2016, pp. 1117-1123.e2. Pubmed, doi:10.1016/j.amjmed.2016.05.007.
Renda G, Zimarino M, Ricci F, Piccini JP, Ezekowitz MD, Patel MR, Cappato R, Giugliano RP, De Caterina R. Efficacy and Safety of Non-Vitamin K Antagonist Oral Anticoagulants After Cardioversion for Nonvalvular Atrial Fibrillation. Am J Med. 2016 Oct;129(10):1117-1123.e2.
Journal cover image

Published In

Am J Med

DOI

EISSN

1555-7162

Publication Date

October 2016

Volume

129

Issue

10

Start / End Page

1117 / 1123.e2

Location

United States

Related Subject Headings

  • Warfarin
  • Treatment Outcome
  • Thromboembolism
  • Stroke
  • Rivaroxaban
  • Pyridones
  • Pyrazoles
  • Odds Ratio
  • Humans
  • Hemorrhage