Key result
Direct oral anticoagulants demonstrated similar efficacy and safety to vitamin K antagonists in patients undergoing cardioversion for atrial fibrillation, with edoxaban showing a 0.5% versus 1.0% rate of composite thromboembolic events (OR 0.46).
Why the study?
Are direct oral anticoagulants safe and effective compared to warfarin for patients with persistent atrial fibrillation undergoing cardioversion?
Are direct oral anticoagulants safe and effective compared to warfarin for patients with persistent atrial fibrillation undergoing cardioversion?
Effect estimate: OR 0.46 (95% CI 0.12-1.43)
Absolute Event Rate: 0.5% vs 1%
DOACs offer a safe, effective, and more practical alternative to warfarin for patients undergoing cardioversion for atrial fibrillation, reducing procedural delays.
Supports DOAC preference in cardioversion to reduce delays; leaves open dedicated randomized confirmation.
Anticoagulation is routinely prescribed to patients with persistent AF before cardioversion to reduce the risk of thromboembolic events. As direct oral anticoagulants (DOACs) have a rapid onset of action, a consistent anticoagulant effect, if taken correctly, and do not need monitoring or dose adjustments, there is considerable interest in their use for patients with AF undergoing cardioversion. Post-hoc analyses show that DOACs are safe to use prior to and following cardioversion. In addition, two randomised controlled trials, X-VeRT and ENSURE-AF, have demonstrated the efficacy and safety of the DOACs rivaroxaban and edoxaban, respectively, in this setting. The use of DOACs allows cardioversions to be performed promptly and reduces the number of cancelled procedures compared with the use of warfarin.
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Goette et al. (2017) conducted a review in Atrial Fibrillation. Direct oral anticoagulants (DOACs) vs. Vitamin K antagonists (VKAs) / Warfarin was evaluated on Composite of stroke, systemic embolic event, MI and cardiovascular mortality (ENSURE-AF trial) (OR 0.46, 95% CI 0.12-1.43). Direct oral anticoagulants demonstrated similar efficacy and safety to vitamin K antagonists in patients undergoing cardioversion for atrial fibrillation, with edoxaban showing a 0.5% versus 1.0% rate of composite thromboembolic events (OR 0.46).
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