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

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• 作者：Giulia Renda ; MD ; PhD^a ; Marco Zimarino ; MD ; PhD^a ; Fabrizio Ricci ; MD^a ; Jonathan P. Piccini ; MD^b ; Michael D. Ezekowitz ; MD ; PhD^c ; Manesh R. Patel ; MD ; PhD^b ; Riccardo Cappato ; MD^d ; Robert P. Giugliano ; MD^e ; Raffaele De Caterina ; MD ; PhD^a ; ^{rdecater@unich.it" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Atrial fibrillation ; Cardioversion ; Major bleeding ; Non-vitamin K antagonist oral anticoagulants ; Stroke ; Vitamin K antagonists
• 刊名：The American Journal of Medicine
• 出版年：2016
• 出版时间：October 2016
• 年：2016
• 卷：129
• 期：10
• 页码：1117-1123.e2
• 全文大小：900 K

文摘

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, I² = 0% for stroke/systemic embolism; P = .47; I² = 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.