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Clinical Performance of Apixaban vs. Vitamin K Antagonists in Patients with Atrial Fibrillation Undergoing Direct Electrical Current Cardioversion: A Prospective Propensity Score-Matched Cohort Study.
Clinical Performance of Apixaban vs. Vitamin K Antagonists in Patients with Atrial Fibrillation Undergoing Direct Electrical Current Cardioversion: A Prospective Propensity Score-Matched Cohort Study.
- Source :
-
American journal of cardiovascular drugs : drugs, devices, and other interventions [Am J Cardiovasc Drugs] 2019 Aug; Vol. 19 (4), pp. 421-427. - Publication Year :
- 2019
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Abstract
- Introduction: Atrial fibrillation (AF) is associated with an increased risk of thromboembolic events.<br />Objectives: This study compared the long-term efficacy and safety of apixaban with that of uninterrupted vitamin K antagonist (VKA) therapy in patients with AF scheduled for transesophageal echocardiogram (TEE)-guided direct current cardioversion (DCC) from June 2014 to September 2016.<br />Methods: We enrolled consecutive patients with persistent nonvalvular AF scheduled to undergo DCC. Patients received apixaban 5 mg or 2.5 mg twice daily (bid) or VKA at therapeutic doses for at least 3 weeks before and 4 weeks after DCC. All patients underwent anamnestic, clinical, electrocardiographic, and echocardiographic evaluation at each follow-up visit and were followed-up for 12 months. The primary efficacy endpoint was the composite of stroke/transient ischemic attack and systemic embolism. The primary safety endpoint was major bleeding.<br />Results: After propensity score matching, comparative treatment groups comprised 182 (75.8%) patients receiving apixaban 5 mg bid and 182 receiving VKA. A low incidence of atrial thrombus (0.5%) at TEE was found in both groups. The acute cardioversion success rate was 86.1% in the apixaban group (156/181) and 83.9% in the VKA group (152/181). During the follow-up period, a similarly low incidence of thromboembolic events (1.1%) was reported in both groups; the bleeding safety profile tended to favor apixaban over VKA (1.1 vs. 1.6%; pā=ā0.3).<br />Conclusions: Newly initiated anticoagulation with apixaban in patients with nonvalvular AF scheduled for TEE-guided DCC seems to be as effective and safe as uninterrupted VKA therapy during 12 months of follow-up.
- Subjects :
- Aged
Electric Countershock methods
Embolism drug therapy
Factor Xa Inhibitors adverse effects
Female
Fibrinolytic Agents therapeutic use
Hemorrhage chemically induced
Humans
Male
Middle Aged
Propensity Score
Prospective Studies
Pyrazoles adverse effects
Pyridones adverse effects
Stroke drug therapy
Thromboembolism drug therapy
Anticoagulants therapeutic use
Atrial Fibrillation drug therapy
Factor Xa Inhibitors therapeutic use
Pyrazoles therapeutic use
Pyridones therapeutic use
Vitamin K antagonists & inhibitors
Subjects
Details
- Language :
- English
- ISSN :
- 1179-187X
- Volume :
- 19
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- American journal of cardiovascular drugs : drugs, devices, and other interventions
- Publication Type :
- Academic Journal
- Accession number :
- 30838557
- Full Text :
- https://doi.org/10.1007/s40256-019-00341-9