Comparison of Apixaban with Warfarin for the Prevention of Subclinical Cerebral Infarction after Direct Current Cardioversion in Patients with Atrial Fibrillation

Subclinical cerebral infarction might be developed even adequate oral anticoagulation after direct current cardioversion (DCCV) in patients with atrial fibrillation (AF). Although apixaban is preferred to prevent thromboembolism and minimize bleeding risk in patients with AF, clinical outcomes after DCCV have not been known well. This study aimed to compare the occurrence of subclinical infarction between apixaban and warfarin in patients with AF after DCCV. A total of 60 patients diagnosed with non-valvular AF were randomized to receive either Apixaban or warfarin. At least 3-week anticoagulation was warranted before DCCV. Brain magnetic resonance image (MRI) was checked 3 days later after DCCV. All of the patients were followed upto 1-month. The primary end-point was the occurrence of subclinical infarction, while secondary end-point included death, stroke, and hospitalization due to heart failure. Safety end-point focused on major bleeding. Micro-embolic infarction causing subclinical infarction were not observed in the warfarin group, while 1 patient (4.3%) in the apixaban group, without statistical difference. Stroke and hospitalization were not developed at both groups. Brain MRI revealed micro-bleeding in 1 patient (4.3%) in the apixaban group, while there was no major or micro-bleeding in the warfarin group. The incidence of micro-embolic events causing subclinical infarction following DCCV was comparable between apixaban and warfarin. Clinical outcomes after DCCV were comparable between the 2 groups. These findings suggest that both apixban and warfarin exhibit similar safety and efficacy profiles during DCCV.