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Direct oral anticoagulants in patients undergoing cardioversion: insight from randomized clinical trials

Stefania Angela Di Fusco, Furio Colivicchi, Nadia Aspromonte, Marco Tubaro, Alessandro Aiello, Massimo Santini
  • Furio Colivicchi
    San Filippo Neri Hospital, Italy
  • Nadia Aspromonte
    San Filippo Neri Hospital, Italy
  • Marco Tubaro
    San Filippo Neri Hospital, Italy
  • Alessandro Aiello
    San Filippo Neri Hospital, Italy
  • Massimo Santini
    San Filippo Neri Hospital, Italy

Abstract

Anticoagulation, reducing the risk of thromboembolic events in patients undergoing cardioversion, is a cornerstone of peri-cardioversion management in patients with atrial fibrillation. We aimed to analyse published data on the efficacy and safety of direct oral anticoagulants (DOACs) in patients undergoing cardioversion. We performed a systematic review of randomized prospective clinical trials (RCTs) comparing DOACs with warfarin and reporting data on post-cardioversion outcomes of interest. Outcomes of interest were stroke, systemic thromboembolic events and major bleeding. We reviewed a total of six RCTs including 3900 cardioversions performed using a DOAC for thromboembolic prophylaxis. These studies reported a low incidence overall of adverse outcomes associated with the use of DOACs (around 1% in all studies, except the ROCKET post-hoc study which included ablation procedures). The incidence rate of adverse events during DOAC treatment was found to be very similar to that observed with warfarin anticoagulation. In RCTs DOAC treatment in patients undergoing cardioversion appears to be effective and safe. However, because evidence in this clinical setting is still weak, observational reports could be useful in providing further data about peri-procedural outcomes.

Keywords

Oral anticoagulants; atrial fibrillation; cardioversion; randomized clinical trials.

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Submitted: 2016-12-16 23:30:14
Published: 2017-05-18 10:46:56
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Copyright (c) 2017 Stefania Angela Di Fusco, Furio Colivicchi, Nadia Aspromonte, Marco Tubaro, Alessandro Aiello, Massimo Santini

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