New oral anticoagulants versus vitamin K antagonists before cardioversion of atrial fibrillation: a meta-analysis of data from 4 randomized trials

Q: What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Atrial fibrillation undergoing cardioversion (n=4268). Intervention: New oral anticoagulants (NOACs) vs. Vitamin K antagonists (VKAs). Primary outcome: Incidence of stroke or systemic embolism and the incidence of major bleeding within 30 days (RR 0.73, p=0.47).

Key Result

NOACs showed no significant difference versus vitamin K antagonists for stroke or systemic embolism (RR 0.73, p=0.47) or major bleeding (RR 1.39, p=0.13) after cardioversion of atrial fibrillation.

Study Design

Type

Meta-Analysis (n=4,268)

Structured PICO

Do new oral anticoagulants (NOACs) reduce stroke, systemic embolism, or major bleeding compared to vitamin K antagonists in patients undergoing cardioversion of atrial fibrillation?

Population

Patients undergoing cardioversion of atrial fibrillation (4 randomized trials pooling 4,268 cardioversions)

Intervention

New oral anticoagulants (NOACs)

Comparator

Vitamin K antagonists (VKAs)

Outcome

Incidence of stroke or systemic embolism and incidence of major bleeding within 30 dayshard clinical

NOACs appear to have similar efficacy and safety profiles to vitamin K antagonists for patients undergoing cardioversion of atrial fibrillation.

Main Result

Effect estimate: RR 0.73

p-value: p=0.47

Limitations

Requires confirmation in larger clinical series and properly powered randomized trials of newly diagnosed AF

Abstract

BACKGROUND: Scarce data are available about efficacy and safety of new oral anticoagulants (NOACs) for cardioversion (CV) of atrial fibrillation (AF). We performed a meta-analysis of data from randomized studies reporting outcomes of patients receiving NOACs, as compared to vitamin K antagonists (VKAs), and undergoing CV of AF. METHODS: Data from four studies were selected, including 4268 CVs. The primary endpoints were the incidence of stroke or systemic embolism and the incidence of major bleeding within 30 days. RESULTS: There was not any significant difference in the incidence of stroke or systemic embolism between NOACs and VKAs (RR 0.73, p = 0.47) nor in the incidence of major bleeding (RR 1.39, p = 0.13). CONCLUSIONS: We found no evidence of differential outcomes after CV of AF according to treatment with NOACs or VKAs. This finding warrants confirmation in larger clinical series and in the setting of properly powered randomized trials of newly diagnosed AF.

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Cite This Study

Andò et al. (Sun,) conducted a meta-analysis in Atrial fibrillation undergoing cardioversion (n=4,268). New oral anticoagulants (NOACs) vs. Vitamin K antagonists (VKAs) was evaluated on Incidence of stroke or systemic embolism and the incidence of major bleeding within 30 days (RR 0.73, p=0.47). NOACs showed no significant difference versus vitamin K antagonists for stroke or systemic embolism (RR 0.73, p=0.47) or major bleeding (RR 1.39, p=0.13) after cardioversion of atrial fibrillation.

synapsesocial.com/papers/6a0ea47c53f874f2b22296f0 https://doi.org/https://doi.org/10.1586/14779072.2015.1024107

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