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

International Journal of Cardiology
Francesco DentaliMatteo Nicola Dario Di Minno

Abstract

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. 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. 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 patient...Continue Reading

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Citations

Mar 31, 2016·Clinical Cardiology·Anna PlittUNKNOWN ENGAGE AF-TIMI 48 Investigators
Sep 1, 2016·Archivos de cardiología de México·Humberto Rodríguez-ReyesGerardo Rodríguez-Diez
Dec 19, 2017·Journal of Atrial Fibrillation·Anna Plitt, Sameer Bansilal
Oct 14, 2017·The Annals of Pharmacotherapy·Caitlin M GibsonMeredith L Howard
Apr 28, 2020·Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology·Axel BrandesIsabelle C Van Gelder
Aug 26, 2021·Journal of the American Heart Association·Amgad MentiasMary Vaughan Sarrazin

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