Abstract
BackgroundNonvitamin K antagonist oral anticoagulants (NOACs) are increasingly used in patients with atrial fibrillation (AF) undergoing elective cardioversion (ECV). The aim was to investigate the use of NOACs and warfarin in ECV in a real‐life setting and to assess how the chosen regimen affected the delay to ECV and rate of complications.MethodsConsecutive AF patients undergoing ECVs in the city hospitals of Helsinki between January 2015 and December 2016 were studied. Data on patient characteristics, delays to cardioversion, anticoagulation treatment, acute (<30 days) complications, and regimen changes within one year were evaluated.ResultsNine hundred patients (59.2% men; mean age, 68.0 ± 10.0) underwent 992 ECVs, of which 596 (60.0%) were performed using NOACs and 396 (40.0%) using warfarin. The mean CHA2DS2‐VASc score was 2.5 (±1.6). In patients without previous anticoagulation treatment, NOACs were associated with a shorter mean time to cardioversion than warfarin (51 versus. 68 days, respectively; p < .001). Six thromboembolic events (0.6%) occurred: 4 (0.7%) in NOAC‐treated patients and 2 (0.5%) in warfarin‐treated patients. Clinically relevant bleeding events occurred in seven patients (1.8%) receiving warfarin and three patients (0.5%) receiving NOACs. Anticoagulation treatment was altered for 99 patients (11.0%) during the study period, with the majority (88.2%) of changes from warfarin to NOACs.ConclusionsIn this real‐life study, the rates of thromboembolic and bleeding complications were low in AF patients undergoing ECV. Patients receiving NOAC therapy had a shorter time to cardioversion and continued their anticoagulation therapy more often than patients on warfarin.
Highlights
Nonvitamin K antagonist oral anticoagulants (NOACs) are increasingly used in patients with atrial fibrillation (AF) undergoing elective cardioversion (ECV)
The CHA2DS2-VASc score was higher in the warfarin group than in the NOAC group (p < .001)
In patients who started warfarin treatment, the mean time to cardioversion was 68 ± 42 days, and the median time 4 | DISCUSSION. The results of this real-life study showed that NOACs were associated with a shorter time to cardioversion and fewer postponements of scheduled ECVs than warfarin
Summary
This study included consecutive patients undergoing ECV of AF or atrial flutter with NOACs (dabigatran, rivaroxaban, and apixaban) or warfarin at the Haartman and Malmi hospitals of Helsinki city from January 1, 2015, to December 31, 2016. All patients who experienced a stroke or TIA had adequate anticoagulation therapy for at least 3 weeks preceding the cardioversion, and both patients in the warfarin group had an INR value > 2 when thromboembolic complications occurred. In patients who started warfarin treatment, the mean time to cardioversion was 68 ± 42 days, and the median time 4 | DISCUSSION The results of this real-life study showed that NOACs were associated with a shorter time to cardioversion and fewer postponements of scheduled ECVs than warfarin. The rate for switches between OACs was lower than those of earlier studies (Beyer-Westendorf et al, 2015; Hellfritzsch et al, 2017), which indicate that more emphasis was placed on achieving high treatment persistence in AF patients with scheduled ECVs. Most of the changes were from warfarin to NOACs, and the most common reasons for treatment changes were labile INR values and patient preference. Thromboembolic or bleeding complications were rarely the reasons for changing between OACs
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
