Efficacy and safety of direct oral anticoagulants in patients undergoing cardioversion for atrial fibrillation: A systematic review and meta-analysis of the literature

Francesco Dentali, Giovanni Luca Botto, Monica Gianni, Pasquale Ambrosino, Matteo Nicola Dario Di Minno

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Background DOACs are increasingly used in patients with NVAF. Information on efficacy and safety of these compounds in patients undergoing electrical or pharmacological cardioversion is limited. Thus, we performed a systematic review and a meta-analysis of the literature to address this issue. Methods Randomized controlled trials comparing the efficacy and safety of DOACs and VKAs in patients with NVAF were systematically searched in Medline, Web of Science, Scopus, Cochrane, and EMBASE databases (up to September 2014). Pooled relative risk (RR) and the corresponding 95% confidence interval (CI) were calculated for each outcome. Results Four randomized controlled trials (3635 patients), for a total of 4517 cardioversions (2869 with DOACs and 1648 with VKAs), were included in the analysis. DOACs and VKAs appeared equally effective in the prevention of stroke/systemic embolism (0.41% vs 0.61%; RR: 0.73, 95% CI: 0.31, 1.72; P = 0.48) and of post-cardiovascular death (0.52% vs 0.81%; RR: 0.73, 95% CI: 0.27, 2.03; P = 0.55), with a similar risk of major bleeding complications (0.81% vs 0.60%; RR: 1.23, 95% CI: 0.55, 2.71). Heterogeneity among studies was generally absent. Furthermore, the Weighted Mean Incidence (WMI) of complications appeared very low in patients randomized to DOACs (WMI: 0.6% and 0.9% for stroke/systemic embolism and major bleeding, respectively). Conclusion Our results suggest that DOACs are at least as effective and safe as VKAs in patients with NVAF undergoing to an electrical or pharmacological cardioversion. Thus, DOACs may be considered a valid and practical alternative to VKAs.

Original languageEnglish
Pages (from-to)72-77
Number of pages6
JournalInternational Journal of Cardiology
Volume185
DOIs
Publication statusPublished - Apr 15 2015

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Electric Countershock
Anticoagulants
Atrial Fibrillation
Meta-Analysis
Safety
Confidence Intervals
Embolism
Randomized Controlled Trials
Stroke
Pharmacology
Hemorrhage
Incidence
Databases

Keywords

  • Atrial fibrillation
  • Cardioversion
  • Direct oral anticoagulants

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Medicine(all)

Cite this

Efficacy and safety of direct oral anticoagulants in patients undergoing cardioversion for atrial fibrillation : A systematic review and meta-analysis of the literature. / Dentali, Francesco; Botto, Giovanni Luca; Gianni, Monica; Ambrosino, Pasquale; Di Minno, Matteo Nicola Dario.

In: International Journal of Cardiology, Vol. 185, 15.04.2015, p. 72-77.

Research output: Contribution to journalArticle

Dentali, Francesco ; Botto, Giovanni Luca ; Gianni, Monica ; Ambrosino, Pasquale ; Di Minno, Matteo Nicola Dario. / Efficacy and safety of direct oral anticoagulants in patients undergoing cardioversion for atrial fibrillation : A systematic review and meta-analysis of the literature. In: International Journal of Cardiology. 2015 ; Vol. 185. pp. 72-77.
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abstract = "Background DOACs are increasingly used in patients with NVAF. Information on efficacy and safety of these compounds in patients undergoing electrical or pharmacological cardioversion is limited. Thus, we performed a systematic review and a meta-analysis of the literature to address this issue. Methods Randomized controlled trials comparing the efficacy and safety of DOACs and VKAs in patients with NVAF were systematically searched in Medline, Web of Science, Scopus, Cochrane, and EMBASE databases (up to September 2014). Pooled relative risk (RR) and the corresponding 95{\%} confidence interval (CI) were calculated for each outcome. Results Four randomized controlled trials (3635 patients), for a total of 4517 cardioversions (2869 with DOACs and 1648 with VKAs), were included in the analysis. DOACs and VKAs appeared equally effective in the prevention of stroke/systemic embolism (0.41{\%} vs 0.61{\%}; RR: 0.73, 95{\%} CI: 0.31, 1.72; P = 0.48) and of post-cardiovascular death (0.52{\%} vs 0.81{\%}; RR: 0.73, 95{\%} CI: 0.27, 2.03; P = 0.55), with a similar risk of major bleeding complications (0.81{\%} vs 0.60{\%}; RR: 1.23, 95{\%} CI: 0.55, 2.71). Heterogeneity among studies was generally absent. Furthermore, the Weighted Mean Incidence (WMI) of complications appeared very low in patients randomized to DOACs (WMI: 0.6{\%} and 0.9{\%} for stroke/systemic embolism and major bleeding, respectively). Conclusion Our results suggest that DOACs are at least as effective and safe as VKAs in patients with NVAF undergoing to an electrical or pharmacological cardioversion. Thus, DOACs may be considered a valid and practical alternative to VKAs.",
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T1 - Efficacy and safety of direct oral anticoagulants in patients undergoing cardioversion for atrial fibrillation

T2 - A systematic review and meta-analysis of the literature

AU - Dentali, Francesco

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AU - Gianni, Monica

AU - Ambrosino, Pasquale

AU - Di Minno, Matteo Nicola Dario

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N2 - Background DOACs are increasingly used in patients with NVAF. Information on efficacy and safety of these compounds in patients undergoing electrical or pharmacological cardioversion is limited. Thus, we performed a systematic review and a meta-analysis of the literature to address this issue. Methods Randomized controlled trials comparing the efficacy and safety of DOACs and VKAs in patients with NVAF were systematically searched in Medline, Web of Science, Scopus, Cochrane, and EMBASE databases (up to September 2014). Pooled relative risk (RR) and the corresponding 95% confidence interval (CI) were calculated for each outcome. Results Four randomized controlled trials (3635 patients), for a total of 4517 cardioversions (2869 with DOACs and 1648 with VKAs), were included in the analysis. DOACs and VKAs appeared equally effective in the prevention of stroke/systemic embolism (0.41% vs 0.61%; RR: 0.73, 95% CI: 0.31, 1.72; P = 0.48) and of post-cardiovascular death (0.52% vs 0.81%; RR: 0.73, 95% CI: 0.27, 2.03; P = 0.55), with a similar risk of major bleeding complications (0.81% vs 0.60%; RR: 1.23, 95% CI: 0.55, 2.71). Heterogeneity among studies was generally absent. Furthermore, the Weighted Mean Incidence (WMI) of complications appeared very low in patients randomized to DOACs (WMI: 0.6% and 0.9% for stroke/systemic embolism and major bleeding, respectively). Conclusion Our results suggest that DOACs are at least as effective and safe as VKAs in patients with NVAF undergoing to an electrical or pharmacological cardioversion. Thus, DOACs may be considered a valid and practical alternative to VKAs.

AB - Background DOACs are increasingly used in patients with NVAF. Information on efficacy and safety of these compounds in patients undergoing electrical or pharmacological cardioversion is limited. Thus, we performed a systematic review and a meta-analysis of the literature to address this issue. Methods Randomized controlled trials comparing the efficacy and safety of DOACs and VKAs in patients with NVAF were systematically searched in Medline, Web of Science, Scopus, Cochrane, and EMBASE databases (up to September 2014). Pooled relative risk (RR) and the corresponding 95% confidence interval (CI) were calculated for each outcome. Results Four randomized controlled trials (3635 patients), for a total of 4517 cardioversions (2869 with DOACs and 1648 with VKAs), were included in the analysis. DOACs and VKAs appeared equally effective in the prevention of stroke/systemic embolism (0.41% vs 0.61%; RR: 0.73, 95% CI: 0.31, 1.72; P = 0.48) and of post-cardiovascular death (0.52% vs 0.81%; RR: 0.73, 95% CI: 0.27, 2.03; P = 0.55), with a similar risk of major bleeding complications (0.81% vs 0.60%; RR: 1.23, 95% CI: 0.55, 2.71). Heterogeneity among studies was generally absent. Furthermore, the Weighted Mean Incidence (WMI) of complications appeared very low in patients randomized to DOACs (WMI: 0.6% and 0.9% for stroke/systemic embolism and major bleeding, respectively). Conclusion Our results suggest that DOACs are at least as effective and safe as VKAs in patients with NVAF undergoing to an electrical or pharmacological cardioversion. Thus, DOACs may be considered a valid and practical alternative to VKAs.

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