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Direct Oral Anticoagulants in Cardioversion: A Review of Current Evidence
Caitlin M Gibson1, Amanda N Basto2, Meredith L Howard1
11 University of North Texas System College of Pharmacy, Fort Worth, TX, USA.
Objective:
Direct oral anticoagulants (DOACs) are recommended for the prevention of stroke or systemic embolism in nonvalvular atrial fibrillation. Dabigatran, rivaroxaban, apixaban, and edoxaban represent possible alternatives to warfarin in the setting of cardioversion. A literature review was conducted to evaluate the safety and efficacy of DOAC use pericardioversion.
Data Sources:
A PubMed and MEDLINE search through August 2017 was conducted using the following search terms alone or in various combinations: dabigatran, rivaroxaban, apixaban, edoxaban, betrixaban, DOAC, NOAC, TSOAC, cardioversion.
Study Selection And Data Extraction:
All English-language, human studies comparing the safety and efficacy of DOACs with that of other anticoagulants in the setting of cardioversion were eligible for inclusion. References from published articles were reviewed for additional relevant citations for study inclusion. Four retrospective and 2 prospective trials comparing DOACs with warfarin were identified.
Data Synthesis:
The majority of studies included patients undergoing electric cardioversion. Based on current evidence, the DOACs perform similarly to warfarin in the prevention of stroke and systemic embolism, and bleeding rates are comparable.
Conclusions:
DOACs may be an attractive alternative to warfarin because of fast onset of action, potentially reducing delay to cardioversion. More robust studies are needed in patients with renal dysfunction and patients undergoing pharmacological cardioversion.
Insights
Direct oral anticoagulants (DOACs) are as safe and effective as warfarin for preventing stroke during cardioversion. Their rapid action may shorten the time to cardioversion, offering a potential advantage over warfarin.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Medicine
Background:
- Direct oral anticoagulants (DOACs) are recommended for stroke prevention in nonvalvular atrial fibrillation.
- DOACs offer potential alternatives to warfarin for cardioversion procedures.
Purpose of the Study:
- To evaluate the safety and efficacy of DOACs compared to warfarin for cardioversion in patients with nonvalvular atrial fibrillation.
Main Methods:
- A literature review of PubMed and MEDLINE databases was performed up to August 2017.
- Included English-language human studies comparing DOACs with other anticoagulants during cardioversion.
- Four retrospective and two prospective trials comparing DOACs with warfarin were identified.
Main Results:
- DOACs demonstrated comparable efficacy to warfarin in preventing stroke and systemic embolism.
- Bleeding rates associated with DOACs were similar to those observed with warfarin.
- The majority of included studies focused on electric cardioversion.
Conclusions:
- DOACs represent a safe and effective alternative to warfarin for cardioversion.
- The rapid onset of action of DOACs may facilitate earlier cardioversion.
- Further research is needed for patients with renal dysfunction and those undergoing pharmacological cardioversion.