Key result
Among atrial fibrillation patients scheduled for electrical cardioversion, NOACs were associated with similar rates of thromboembolic events (0.6% vs 0.8%; P=0.7) compared to VKAs.
Why the study?
The study was conducted to evaluate the safety and effectiveness of NOACs compared with VKAs in AF patients undergoing electrical cardioversion.
Do non-vitamin K antagonist oral anticoagulants (NOACs) reduce thromboembolic events and major bleeding compared to vitamin K antagonists (VKAs) in atrial fibrillation patients scheduled for electrical cardioversion?
Observational (n=990)
Do non-vitamin K antagonist oral anticoagulants (NOACs) reduce thromboembolic events and major bleeding compared to vitamin K antagonists (VKAs) in atrial fibrillation patients scheduled for electrical cardioversion?
Absolute Event Rate: 0.6% vs 0.8%
p-value: p=0.7
In a real-world setting, NOACs demonstrate comparable safety and effectiveness to VKAs in AF patients undergoing electrical cardioversion, with significantly better treatment adherence.
Comparable safety of NOACs versus VKAs for cardioversion; should not change practice and leaves open need for RCTs.
Aim: The aim of the present study was to assess the safety and effectiveness of non-vitamin K antagonist oral anticoagulants (NOACs) versus vitamin K antagonists (VKAs) in atrial fibrillation (AF) patients undergoing electrical cardioversion (EC). Methods: A propensity score-matched analysis was performed in order to identify two homogeneous groups including AF patients on NOACs and VKAs treatment scheduled for EC. The primary safety endpoint was major bleeding. The composite of stroke, transient ischemic attack (TIA) and systemic embolism (SE) was the primary effectiveness endpoint. The discontinuation rate of anticoagulant therapy was assessed. Results: A total of 495 AF patients on NOACs therapy and scheduled for EC were compared to 495 VKAs recipients. No statistically significant differences in the incidence of both major bleeding (1.01% versus 1.4%; P = 0.5) and thromboembolic events (0.6% versus 0.8%; P = 0.7) were observed during a mean follow-up of 15 ± 3 months. The discontinuation rate of NOACs was significantly lower compared to VKAs (1.6% versus 3.6%, P =0.04). Conclusion: We showed a safe and effective clinical profile of NOACs among AF patients scheduled for electrical cardioversion in real-life setting. Patients on NOACs therapy showed a lower discontinuation rate compared to those on VKAs.
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Rago et al. (2021) conducted an observational in Atrial fibrillation (n=990). Non-vitamin K antagonist oral anticoagulants (NOACs) vs. Vitamin K antagonists (VKAs) was evaluated on Composite of stroke, transient ischemic attack (TIA) and systemic embolism (SE) (p=0.7). Among atrial fibrillation patients scheduled for electrical cardioversion, NOACs were associated with similar rates of thromboembolic events (0.6% vs 0.8%; P=0.7) compared to VKAs.
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