Non-vitamin K antagonists oral anticoagulants are as safe and effective as warfarin for cardioversion of atrial fibrillation: A systematic review and meta-analysis

Telles-Garcia, Nelson A; Dahal, Khagendra; Kocherla, Cyrus; Lip, Gregory Y.H.; Reddy, Pratap; Dominic, Paari

doi:10.1016/j.ijcard.2018.04.034

Cited by 31 publications

(17 citation statements)

References 23 publications

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“…The trial showed a significant reduction with apixaban in strokes (0% vs. 0.8%) and in major bleeding (0.4% vs. 0.8%) at 30 days compared to warfarin. The favorable clinical profile of NOACs in patients undergoing CV has also been confirmed in a recent metanalysis [59,60] and in real-world studies [61,62,63,64,65,66].…”

Section: Prevention and Treatment Of Left Atrial Appendage Thrombosismentioning

confidence: 64%

Diagnosis and Management of Left Atrium Appendage Thrombosis in Atrial Fibrillation Patients Undergoing Cardioversion

et al. 2019

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Atrial fibrillation is the most common cardiac arrhythmia and is associated with an increased risk of stroke and thromboembolic complications. A rhythm control strategy with both electrical and pharmacological cardioversion is recommended for patients with symptomatic atrial fibrillation. Anticoagulant therapy for 3–4 weeks prior to cardioversion is recommended in order to avoid thromboembolic events deriving from restoring sinus rhythm. Transesophageal echocardiography has a pivotal role in this setting, excluding the presence of left atrial appendage thrombus before cardioversion. The aim of this review is to discuss the epidemiology and risk factors for left atrial appendage thrombosis, the role of echocardiography in the decision making before cardioversion, and the efficacy of different anticoagulant regimens on the detection and treatment of left atrial appendage thrombosis.

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Section: Prevention and Treatment Of Left Atrial Appendage Thrombosismentioning

confidence: 64%

Diagnosis and Management of Left Atrium Appendage Thrombosis in Atrial Fibrillation Patients Undergoing Cardioversion

et al. 2019

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“…Taken together, it appears safe to state that the combined knowledge base shows at least the same protection provided by NOACs as compared to VKAs against stroke and systemic embolism after cardioversion [16].…”

Section: Incidence Of Thromboembolic Complications In Cardioversion Umentioning

confidence: 91%

Cardioversion Safety – Are We Doing Enough?

et al. 2020

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There is a considerable periprocedural risk of thromboembolic events in atrial fibrillation patients undergoing cardioversion, and treatment with anticoagulants is therefore a hallmark of cardioversion safety. Based on retrospective subgroup analyses and prospective studies, non-vitamin K anticoagulants are at least as efficient as vitamin K-antagonists in preventing thromboembolic complications after cardioversion. The risk of thromboembolic complications after cardioversion very much depends on the comorbidities in a given patient, and especially heart failure, diabetes, and age >75 years carry a markedly increased risk. Cardioversion has been considered safe within a 48-h time window after onset of atrial fibrillation without prior treatment with anticoagulants, but recent studies have set this practice into question based on e.g. erratic debut assessment of atrial fibrillation. Therefore, a simple and more practical approach is here suggested, where early cardioversion is performed only in hemodynamically unstable patients.

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“…These results were later confirmed in the above-discussed dedicated cardioversion trials as well as in various meta-analyses and ‘real world’ studies. 16–18 Although none of these studies include sufficient patient numbers to formally demonstrate statistically non-inferiority, the available evidence strongly suggests that cardioversion under regular and continued NOAC intake is reasonably safe. 5 , 7 One important prerequisite, however, is adequate adherence and correct (on-label) dosing of NOAC therapy prior to cardioversion.…”

Section: Cardioversionmentioning

confidence: 99%

Non-vitamin K antagonist oral anticoagulants therapy for atrial fibrillation patients undergoing electrophysiologic procedures

Steffel¹

2020

European Heart Journal Supplements

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Over the last 10 years since the introduction of non-vitamin K antagonist oral anticoagulants (NOACs) into routine clinical practice our experience with these drugs has increased tremendously, also in the context of patients undergoing electrophysiology procedures. While some open questions remain, the available evidence indicates that for the majority of cases, these interventions can safely be performed on NOACs if study-based standard operating procedures are in place and followed. This review summarizes the most current trial evidence and guidelines on the use of NOACs for patients undergoing cardioversion, atrial fibrillation ablation, and device implantations, based on previous work of the author and others.

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Non-vitamin K antagonists oral anticoagulants are as safe and effective as warfarin for cardioversion of atrial fibrillation: A systematic review and meta-analysis

Cited by 31 publications

References 23 publications

Diagnosis and Management of Left Atrium Appendage Thrombosis in Atrial Fibrillation Patients Undergoing Cardioversion

Diagnosis and Management of Left Atrium Appendage Thrombosis in Atrial Fibrillation Patients Undergoing Cardioversion

Cardioversion Safety – Are We Doing Enough?

Non-vitamin K antagonist oral anticoagulants therapy for atrial fibrillation patients undergoing electrophysiologic procedures

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