Management of Direct Oral Anticoagulants in Patients with Atrial Fibrillation Undergoing Cardioversion

Coppola, Giuseppe; Manno, Girolamo; Mignano, Antonino; Luparelli, Mirko; Zarcone, Antonino; Novo, Giuseppina; Corrado, Egle

doi:10.3390/medicina55100660

Cited by 4 publications

(5 citation statements)

References 38 publications

(91 reference statements)

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“…Repetition of 24-h Holter recording can detect AF at a higher rate, as it was also demonstrated in the present study, but it still carries lower diagnostic yield compared to continuous arrhythmia monitoring [29]. The detection of occult PAF has important therapeutic implications in CS patients, as anticoagulation is the optimal treatment for secondary stroke prevention in AF-associated stroke and can substantially reduce recurrent stroke and systemic embolism compared to antiplatelet therapy [30,31,32,33,34]. Furthermore, secondary prevention in CS includes oral anticoagulation when AF is detected, regardless of AF pattern (paroxysmal or chronic).…”

Section: Discussionmentioning

confidence: 56%

Potential Utility of Neurosonology in Paroxysmal Atrial Fibrillation Detection in Patients with Cryptogenic Stroke

Liantinioti

Palaiodimou

Tympas

et al. 2019

JCM

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Background: Occult paroxysmal atrial fibrillation (PAF) is a common and potential treatable cause of cryptogenic stroke (CS). We sought to prospectively identify independent predictors of atrial fibrillation (AF) detection in patients with CS and sinus rhythm on baseline electrocardiogram (ECG), without prior AF history. We had hypothesized that cardiac arrhythmia detection during neurosonology examinations (Carotid Duplex (CDU) and Transcranial Doppler (TCD)) may be associated with higher likelihood of AF detection. Methods: Consecutive CS patients were prospectively evaluated over a six-year period. Demographics, clinical and imaging characteristics of cerebral ischemia were documented. The presence of arrhythmia during spectral waveform analysis of CDU/TCD was recorded. Left atrial enlargement was documented during echocardiography using standard definitions. The outcome event of interest included PAF detection on outpatient 24-h Holter ECG recordings. Statistical analyses were performed using univariate and multivariate logistic regression models. Results: A total of 373 patients with CS were evaluated (mean age 60 ± 11 years, 67% men, median NIHSS-score 4 points). The rate of PAF detection of any duration on Holter ECG recordings was 11% (95% CI 8%–14%). The following three variables were independently associated with the likelihood of AF detection on 24-h Holter-ECG recordings in both multivariate analyses adjusting for potential confounders: age (OR per 10-year increase: 1.68; 95% CI: 1.19–2.37; p = 0.003), moderate or severe left atrial enlargement (OR: 4.81; 95% CI: 1.77–13.03; p = 0.002) and arrhythmia detection during neurosonology evaluations (OR: 3.09; 95% CI: 1.47–6.48; p = 0.003). Conclusion: Our findings underline the potential utility of neurosonology in improving the detection rate of PAF in patients with CS.

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Section: Discussionmentioning

confidence: 56%

Potential Utility of Neurosonology in Paroxysmal Atrial Fibrillation Detection in Patients with Cryptogenic Stroke

Liantinioti

Palaiodimou

Tympas

et al. 2019

JCM

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“…The major studies that have tested the safety and efficacy of direct oral anticoagulants (DOACs) have not been conducted in specific populations of patients with hemoglobinopathies. However, it is evident that DOACs are more manageable than warfarin and have a more favorable safety profile [ 58 , 59 ]. Only one study tested the effectiveness of rivaroxaban in a very small group of patients with β-thalassemia and AF.…”

Section: Treatment Optionsmentioning

confidence: 99%

Atrial Fibrillation in β-Thalassemia: Overview of Mechanism, Significance and Clinical Management

Malagù

Marchini

Fiorio

et al. 2022

Biology

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Thalassemia is an inherited blood disorder with worldwide distribution. Transfusion and chelation therapy have radically improved the prognosis of β-thalassemic patients in the developed world, but this has led to the development of new chronic cardiac complications like atrial fibrillation (AF). Prevalence of AF in patients with β-thalassemia is higher than in the general population, ranging from 2 to 33%. Studies are lacking, and the little evidence available comes from a small number of observational studies. The pathophysiology is not well understood but, while iron overload seems to be the principal mechanism, AF could develop even in the absence of iron deposition. Furthermore, the clinical presentation is mainly paroxysmal, and patients are highly symptomatic. The underlying disease, the pathophysiology, and the clinical presentation require a different management of AF in β-thalassemia than in the general population. Rhythm control should be preferred over rate control, and the most important antiarrhythmic therapy is represented by chelation drugs. Thromboembolic risk is high, but the available risk scores are not validated in β-thalassemia, and the choice of anticoagulation therapy should be considered early. The main purpose of this review is to summarize the actual knowledge about AF in β-thalassemia, with a specific focus on the clinical management of these complex patients.

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“…Real-world evidences on clinical performance of non-vitamin K antagonist oral anticoagulant (NOACs) use in AF patients scheduled for DCC are relevant to address current unmet medical needs and to better define the specific role of such agents in this clinical setting. NOACs offer several potential advantages over VKAs in AF patients undergoing cardioversion, removing the need for routine laboratory monitoring and heparin bridging therapy and reducing time to procedure [ 18 ]. The present study is the first real-world experience investigating the safety and effectiveness of newly initiated anticoagulation with edoxaban versus well-controlled VKA therapy in patients with non-valvular AF scheduled for TEE-guided DCC.…”

Section: Discussionmentioning

confidence: 99%

Direct Current Cardioversion in Atrial Fibrillation Patients on Edoxaban Therapy Versus Vitamin K Antagonists: a Real-world Propensity Score–Matched Study

Rago

Papa

Attena³

et al. 2020

Cardiovasc Drugs Ther

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Purpose The purpose of the present study was to compare the long-term effectiveness and safety of newly initiated anticoagulation with edoxaban (EDO) versus uninterrupted vitamin K antagonist (VKA) therapy in patients with atrial fibrillation (AF) scheduled for transesophageal echocardiogram (TEE)-guided direct electrical current cardioversion (DCC). Methods A propensity score-matched cohort observational study was performed comparing the safety and effectiveness of edoxaban versus well-controlled VKA therapy among a cohort of consecutive non-valvular AF patients scheduled for DCC. The primary safety outcome was major bleeding. The primary efficacy outcome was the composite of stroke, transient ischemic attack (TIA), and systemic embolism (SE). Findings A total of 130 AF patients receiving edoxaban 60-mg (EDO) treatment were compared with the same number of VKA recipients. The cumulative incidence of major bleedings was 1.54% in the EDO group and 3.08% in the VKA group (P = 0.4). The cumulative incidence of thromboembolic events was 1.54% in the EDO group and 2.31% in the VKA group (P = 0.9). A non-significant trend in improved adherence was observed between the EDO and VKA groups with a total anticoagulant therapy discontinuation rate of 4.62% (6/130) vs 6.15% (8/130), respectively (P = 0.06). Implications Our study provides the evidence of a safe and effective use of edoxaban in this clinical setting, justified by no significant difference in major bleedings and thromboembolic events between edoxaban and well-controlled VKA treatments.

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Management of Direct Oral Anticoagulants in Patients with Atrial Fibrillation Undergoing Cardioversion

Cited by 4 publications

References 38 publications

Potential Utility of Neurosonology in Paroxysmal Atrial Fibrillation Detection in Patients with Cryptogenic Stroke

Potential Utility of Neurosonology in Paroxysmal Atrial Fibrillation Detection in Patients with Cryptogenic Stroke

Atrial Fibrillation in β-Thalassemia: Overview of Mechanism, Significance and Clinical Management

Direct Current Cardioversion in Atrial Fibrillation Patients on Edoxaban Therapy Versus Vitamin K Antagonists: a Real-world Propensity Score–Matched Study

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