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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.

Authors :
Rago A
Papa AA
Cassese A
Arena G
Magliocca MCG
D'Onofrio A
Golino P
Nigro G
Russo V
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

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€‰=ā€‰0.3).<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.

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