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Novel Oral Anticoagulants for DC Cardioversion Procedures: Utilization and Clinical Outcomes Compared with Warfarin

Corey M Coleman1, Shaden Khalaf1, Steven Mould1

  • 1From the Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio.

Pacing and Clinical Electrophysiology : PACE
|February 28, 2015
PubMed
Abstract

Insights

Novel oral anticoagulants (NOACs) are increasingly used for atrial fibrillation patients undergoing cardioversion, showing comparable safety and effectiveness to warfarin. These agents are associated with low rates of stroke and bleeding complications.

Area of Science:

  • Cardiology
  • Pharmacology
  • Clinical Medicine

Background:

  • Novel oral anticoagulants (NOACs) are increasingly used for thromboembolic prevention in patients with atrial fibrillation undergoing direct current cardioversion (DCCV).
  • Previous analyses suggest NOACs are safe and effective, but real-world utilization and outcomes require further characterization.

Purpose of the Study:

  • To characterize the utilization, effectiveness, and complications of NOAC agents versus warfarin for stroke prophylaxis in patients undergoing DCCV.
  • To analyze trends in NOAC adoption and compare outcomes stratified by patient clinical parameters.

Main Methods:

  • A retrospective analysis of DCCV procedures at Cleveland Clinic from 2009-2013 comparing warfarin and NOACs.
  • Data collected included NOAC utilization rates, cerebrovascular accident (CVA), transient ischemic attack (TIA), peripheral arterial embolism (PAE), and bleeding events within 8 weeks post-procedure.

Main Results:

  • NOAC utilization increased steadily from 2011-2013, accounting for over a third of procedures by the study's end.
  • Rates of CVA/TIA and bleeding were low and not significantly different between warfarin and NOACs (CVA/TIA: 0.97% vs 1.62%, P=0.162; Bleeding: 1.02% vs 0.5%, P=0.247).
  • Higher CHADS2/CHA2DS2-VASC scores, age, chronic kidney disease, diabetes, coronary disease, and DVT/PE were associated with increased thromboembolic and bleeding risks.

Conclusions:

  • NOACs are increasingly utilized and demonstrate comparable safety and effectiveness to warfarin in a high-volume DCCV setting.
  • The study confirms low rates of thromboembolic and bleeding complications with NOACs in this patient population.
  • Risk factors for thromboembolic events and bleeding were identified, emphasizing the need for individualized patient management.
Keywords:
apixabanatrial arrhythmiasatrial fibrillationcardioversiondabigatranoral anticoagulationrivaroxabanstroke prophylaxiswarfarin

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