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Anna Rago,1 Enrica Pezzullo,1 Marco Malvezzi Caracciolo d’Aquino,1 Gabriella Scognamiglio,1 Valentina Maria Caso,2 Francesco Martone,3 Emilio Attena,4 Valentina Parisi,5 Antonio D’Onofrio,4 Paolo Golino,1 Gerardo Nigro,1 Vincenzo Russo1 1Department of Cardiology, Monaldi Hospital, Naples, Italy; 2Department of Medical Translational Sciences, University of the Study of Campania “Luigi Vanvitelli”, Naples, Italy; 3Clinical Biochemistry Unit, Monaldi Hospital, Naples, Italy; 4Departmental Unit of Electrophysiology, Monaldi Hospital, Naples, Italy; 5Department of Translational Medical Sciences, University of Naples Federico II, Naples, ItalyCorrespondence: Vincenzo RussoDepartment of Medical Transalational Sciences, University of Campania - Monaldi Hospital, Via Leonardo Bianchi, Naples, 80131, ItalyFax +39-0817587482Email v.p.russo@libero.itAim: The aim of the present study was to assess the safety and effectiveness of non-vitamin K antagonist oral anticoagulants (NOACs) versus vitamin K antagonists (VKAs) in atrial fibrillation (AF) patients undergoing electrical cardioversion (EC).Methods: A propensity score-matched analysis was performed in order to identify two homogeneous groups including AF patients on NOACs and VKAs treatment scheduled for EC. The primary safety endpoint was major bleeding. The composite of stroke, transient ischemic attack (TIA) and systemic embolism (SE) was the primary effectiveness endpoint. The discontinuation rate of anticoagulant therapy was assessed.Results: A total of 495 AF patients on NOACs therapy and scheduled for EC were compared to 495 VKAs recipients. No statistically significant differences in the incidence of both major bleeding (1.01% versus 1.4%; P= 0.5) and thromboembolic events (0.6% versus 0.8%; P= 0.7) were observed during a mean follow-up of 15 ± 3 months. The discontinuation rate of NOACs was significantly lower compared to VKAs (1.6% versus 3.6%, P=0.04).Conclusion: We

Vincenzo Russo,1 Andrea Paccone,2 Anna Rago,1 Valeria Maddaloni,3 Dario Iafusco,4 Riccardo Proietti,5 Umberto Atripaldi,3 Antonio D’Onofrio,1 Paolo Golino,1 Gerardo Nigro1 1Chair of Cardiology, University of Campania “Luigi Vanvitelli”- Monaldi Hospital, Naples, Italy; 2Chair of Cardiology, University of Bari “Aldo Moro”, Bari, Italy; 3Chemical Biochemistry Unit, Monaldi Hospital, Naples, Italy; 4Department of Pediatrics, University of Campania “Luigi Vanvitelli”, Naples, Italy; 5Chair of Cardiology, University of Padua, Padua, ItalyCorrespondence: Vincenzo RussoChair of Cardiology, University of Campania “Luigi Vanvitelli”-Monaldi Hospital, Via Leonardo Bianchi, Naples 80126, ItalyTel +39 0817062355Email v.p.russo@libero.itAbstract: We present the case of a 45-year-old man with atrial fibrillation and morbid obesity (weight 128 kg, height 168 cm, BMI 45.4) who was switched from Warfarin 5 mg once daily to Apixaban 5 mg twice daily because he did not achieve at least 60% of the time in therapeutic range. We performed serial determinations of apixaban plasma concentration (at 2, 6, 12, 24 hrs after intake) showing drug levels within reference range, even when the patient lose weight.Keywords: atrial fibrillation, obesity, non-vitamin k oral anticoagulant, plasma levels, apixaban, weight loss