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

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.

Keywords:

• atrial fibrillation
• cardioversion
• new oral anticoagulants
• stroke
• vitamin K antagonists

Financial & competing interests disclosure

The authors are supported by their Academic Institution. The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript.

No writing assistance was utilized in the production of this manuscript.

Key issues

• New oral anticoagulants (NOACs) are known as an effective and safe alternative to vitamin K antagonists (VKAs) in patients with non-valvular atrial fibrillation (AF).

• Patients receiving guidelines-recommended anticoagulation, like those enrolled in randomized controlled trials, have a very low risk of ischemic or hemorrhagic stroke after elective cardioversion (CV) of AF.

• We found no differences in efficacy and safety outcomes with respect to treatment with NOACs, as compared to VKAs, in patients undergoing elective CV of AF.

• These results confirm recent single-center observations about efficacy and safety of NOACs in the peri-CV period and support current clinical practice.

• Such findings warrants further confirmation in larger clinical series of patients undergoing CV and, if feasible, in the setting of properly powered randomized trials of newly diagnosed AF.