Cardioversion of atrial fibrillation in a real-world setting: non-vitamin K antagonist oral anticoagulants ensure a fast and safe strategy compared to warfarin

Abstract

In a real-world clinical setting with anticoagulation handled in a structured multidisciplinary AF clinic, the waiting time to cardioversion was shorter with NOACs compared to warfarin. The rates of thromboembolism and major bleeding events were low, with NOACs shown to be as effective and safe as warfarin.

Przywracanie rytmu zatokowego u pacjentów z migotaniem przedsionków leczonych doustnymi antykoagulantami niebędącymi antagonistami witaminy K jest bezpieczne bez przezprzełykowego badania echokardiograficznego — doniesienie wstępne

“…Gawałko et al [9] in a group of 859 patients showed that NOACs were used in 49% of patients undergoing elective cardioversion or ablation due to AF. Fredriksen et al [10] in a study of 2,150 patients hospitalised for elective cardioversion between 2011 and 2016 showed that the percentage of patients treated with NOACs was lower than in the present study, and was 32%. Also, Papp et al [11] showed that in a group of 1,101 patients, NOAC before cardioversion was used in 32% of patients.…”

The 2018 European Heart Rhythm Association Practical Guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation: executive summary

“…Strategia polegająca na podaniu jednej dawki NOAC ≥ 4 h przed kardiowersją (≥ 2 h po nasycającej dawce apiksabanu) wydaje się skuteczna i bezpieczna u pacjentów z AF trwającym ≥ 48 h pod warunkiem wykonania TEE przed kardiowersją. Alternatywą jest rozpoczęcie od razu leczenia przeciwkrzepliwego za pomocą NOAC i odroczenie kardiowersji o co najmniej 3 tygodnie [73][74][75][76][77]. Podobną strategię rozpoczęcia leczenia NOAC przed kardiowersją, z wykonaniem TEE zależnie od możliwości ośrodka lub podwyższonego ryzyka udaru u pacjenta, można stosować u chorych z AF trwającym < 48 h.…”

Efficacy and safety of direct oral anticoagulants in patients undergoing elective electrical cardioversion: A real-world patient population

“…The 2016 ESC AF guidelines recommends the use of therapeutic oral anticoagulation at least 3 weeks before and 4 weeks after ECV [2]. The use of VKA has its limitations, the most important being its narrow therapeutic window requiring regular INR assessments, delayed onset of action and certain drug-drug interactions [11,22]. Considering these limitations, DOACs has become an attractive alternative for VKA [1].…”

“…Nowadays, DOAC is the most commonly used oral anticoagulant pericardioversion. An advantage of the use of DOAC in the setting of ECV is that it can avoid delays or postponement of ECV due to inadequate INR levels with VKA [9,11]. Avoiding postponement and rescheduling of ECV procedures by using DOAC has been shown to be cost-effective in comparison to VKA [25].…”