Practical Implementation of Anticoagulation Strategy for Patients Undergoing Cardioversion of Atrial Fibrillation

Goette, Andreas; Heidbüchel, Hein

doi:10.15420/aer.2017:3:2

Cited by 7 publications

(4 citation statements)

References 38 publications

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“…A thromboembolic event occurred in 6 (0.64%) and 2 (0.41%) patients in the VKA and DOAC group, respectively (P=0.72). The timing of thromboembolic events was similar between groups (VKA: median 19 [10, 25] days; DOAC: 13 [4,22] days, P=0.64). In the 8 patients with a thromboembolic event, 5 patients (63%) had a medical history of prior stroke or TIA (Appendix B).…”

Section: Primary Endpointsmentioning

confidence: 91%

“…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].…”

Section: J O U R N a L P R E -P R O O Fmentioning

confidence: 99%

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

Heide¹,

Wit

Bhagwandien

et al. 2021

International Journal of Cardiology

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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Section: Primary Endpointsmentioning

confidence: 91%

Section: J O U R N a L P R E -P R O O Fmentioning

confidence: 99%

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

Heide¹,

Wit

Bhagwandien

et al. 2021

International Journal of Cardiology

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“…The anticoagulation details and time from referral were recorded for all patients and as such no patients were excluded from the study for lack of appropriate records. Patients receiving rivaroxaban received a 20mg once daily dose (or 15mg in patients with a creatinine clearance of 30-49ml/min)[9], those receiving apixaban received 5mg twice per day (or 2.5mg twice per day if satisfying 2 of the criteria: over 80 years old; creatinine clearance less than 30ml/min; weight less than 60kg), while patients on warfarin were dosed according to INR, with an aim of 2.5–3.5. This INR was then checked on the day of cardioversion to ensure it was above 2.5, to safely proceed with cardioversion.…”

Section: Methodsmentioning

confidence: 99%

Comparing the delay with different anticoagulants before elective electrical cardioversion for atrial fibrillation/flutter

et al. 2019

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AimsTo assess the impact of the introduction of direct oral anticoagulants upon the outcomes from elective electrical cardioversion for atrial fibrillation.MethodsThis is a retrospective comparison of delay to elective cardioversion with different anticoagulants. The data was gathered from a large regional hospital from January 2013 to September 2017. There were 3 measured outcomes: 1) the time in weeks from referral to the date of attempted electrical cardioversion; 2) the proportion of patients who were successfully cardioverted; and 3) the proportion of patients who remained in sinus rhythm by the 12 week follow-up. Time-to-cardioversion was non-parametrically distributed so was analysed with Kruskal-Wallis testing and Mann-Whitney-U testing. Maintenance of sinus rhythm was analysed using z-testing.Results1,374 patients were submitted to cardioversion. The referrals for cardioversion were either from primary care or from cardiologists. At the time of cardioversion, 789 cases were anticoagulated on warfarin (W), 215 on apixaban (A) and 370 on rivaroxaban (R). All 3 cohorts were initially compared independently using Kruskal-Wallis testing. This demonstrated a significant difference in the delay (measured in weeks) between the A and W group (A = 7, W = 9, P<0.00001); the R and W group (R = 7, W = 9, P<0.00001) and no difference between R and A (A = 7, R = 7, P = 0.92). As there was no difference between the A and R groups, they were combined to form the AR group. The AR group was compared to the W group using Mann-Whitney-U testing which demonstrated a significant delay between the groups (AR = 7, W = 9, P<0.00001). Excluding patients with prior or unknown attempts of cardioversion (n = 791), the W patients (n = 152) were less successful in achieving sinus rhythm at cardioversion than the AR (n = 431) group (W = 95% vs AR = 99% P = 0.04). However at 12 weeks, incidence of sinus rhythm was significantly different (W = 40% vs AR = 49% P = 0.049). These groups were compared by z testing. At 12 weeks' follow-up there was no statistical difference in rate of adverse consequences between the AR group and the W group, but the rate of adverse consequences was too low to draw further conclusions.ConclusionDOACs appear to significantly shorten the latency between the decision to cardiovert and the cardioversion procedure by at least 2 weeks compared to warfarin in a real-world setting. In this study, patients who had not previously been cardioverted who were anticoagulated with warfarin had a significantly lower probability of conversion to sinus rhythm and a significantly lower probability to remain in sinus rhythm at the 12 week follow-up compared to the combined apixaban and rivaroxaban group.

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“…55,56 In addition to rate-controlling agents with digoxin or amiodarone, anticoagulant therapy may be administered using vitamin K antagonists or direct oral anticoagulants (DOACs) (heart failure is also a thromboembolic risk for AF). 57,58 Step 5: Rate or rhythm control management and anticoagulation…”

mentioning

confidence: 99%

Rapid Atrial Fibrillation in the Emergency Department

Alsagaff¹,

Susilo²,

Pramudia³

et al. 2022

Heart International

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Atrial fibrillation (AF) is the most common rhythm disorder seen in doctors' offices and emergency departments (EDs). In both settings, an AF holistic pathway including anticoagulation or stroke avoidance, better symptom management, and cardiovascular and comorbidity optimization should be followed. However, other considerations need to be assessed in the ED, such as haemodynamic instability, the onset of AF, the presence of acute heart failure and pre-excitation. Although the Advanced Cardiovascular Life Support guidelines (European Society of Cardiology guidelines, Acute Cardiac Care Association/European Heart Rhythm Association position statements) and several recent AF publications have greatly assisted physicians in treating AF with rapid ventricular response in the ED, further practical clinical guidance is required to improve physicians' skill and knowledge in providing the best treatment for patients. Herein, we combine multiple strategies with supporting evidence-based treatment and experiences encountered in clinical practice into practical stepwise approaches. We hope that the stepwise algorithm may assist residents and physicians in managing AF in the ED.

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Practical Implementation of Anticoagulation Strategy for Patients Undergoing Cardioversion of Atrial Fibrillation

Cited by 7 publications

References 38 publications

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

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

Comparing the delay with different anticoagulants before elective electrical cardioversion for atrial fibrillation/flutter

Rapid Atrial Fibrillation in the Emergency Department

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