Patterns of oral anticoagulation use with cardioversion in clinical practice. Heart (British Cardiac Society) Geurink, K., Holmes, D., Ezekowitz, M. D., Pieper, K., Fonarow, G., Kowey, P. R., Reiffel, J. A., Singer, D. E., Freeman, J., Gersh, B. J., Mahaffey, K. W., Hylek, E. M., Naccarelli, G., Piccini, J. P., Peterson, E. D., Pokorney, S. D. 2020


BACKGROUND: Cardioversion is common among patients with atrial fibrillation (AF). We hypothesised that novel oral anticoagulants (NOAC) used in clinical practice resulted in similar rates of stroke compared with vitamin K antagonists (VKA) for cardioversion.METHODS: Using the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation II, patients with AF who had a cardioversion, follow-up data and an AF diagnosis within 6 months of enrolment were identified retrospectively. Clinical outcomes were compared for patients receiving a NOAC or VKA for 1year following cardioversion.RESULTS: Among 13004 patients with AF, 2260 (17%) underwent cardioversion. 1613 met the inclusion criteria for this analysis. At the time of cardioversion, 283 (17.5%) were receiving a VKA and 1330 (82.5%) a NOAC. A transoesophageal echocardiogram (TOE) was performed in 403 (25%) cardioversions. The incidence of stroke/transient ischaemic attack (TIA) at 30 days was the same for patients having (3.04 per 100 patient-years) or not having (3.04 per 100 patient-years) a TOE (p=0.99). There were no differences in the incidence of death (HR 1.19, 95%CI 0.62 to 2.28, p=0.61), cardiovascular hospitalisation (HR 1.02, 95%CI 0.76 to 1.35, p=0.91), stroke/TIA (HR 1.18, 95%CI 0.30 to 4.74, p=0.81) or bleeding-related hospitalisation (HR 1.29, 95%CI 0.66 to 2.52, p=0.45) at 1year for patients treated with either a NOAC or VKA.CONCLUSIONS: Cardioversion was a low-risk procedure for patients treated with NOAC, and there were statistically similar rates of stroke/TIA 30 days after cardioversion as for patients treated with VKA. There were no statically significant differences in death, stroke/TIA or major bleeding at 1year among patients treated with NOAC compared with VKA after cardioversion.

View details for DOI 10.1136/heartjnl-2019-316315

View details for PubMedID 32591363