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Patterns of oral anticoagulation use with cardioversion in clinical practice
- Source :
- Heart. 107:642-649
- Publication Year :
- 2020
- Publisher :
- BMJ, 2020.
-
Abstract
- BackgroundCardioversion is common among patients with atrial fibrillation (AF). We hypothesised that novel oral anticoagulants (NOAC) used in clinical practice resulted in similar rates of stroke compared with vitamin K antagonists (VKA) for cardioversion.MethodsUsing the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation II, patients with AF who had a cardioversion, follow-up data and an AF diagnosis within 6 months of enrolment were identified retrospectively. Clinical outcomes were compared for patients receiving a NOAC or VKA for 1 year following cardioversion.ResultsAmong 13 004 patients with AF, 2260 (17%) underwent cardioversion. 1613 met the inclusion criteria for this analysis. At the time of cardioversion, 283 (17.5%) were receiving a VKA and 1330 (82.5%) a NOAC. A transoesophageal echocardiogram (TOE) was performed in 403 (25%) cardioversions. The incidence of stroke/transient ischaemic attack (TIA) at 30 days was the same for patients having (3.04 per 100 patient-years) or not having (3.04 per 100 patient-years) a TOE (p=0.99). There were no differences in the incidence of death (HR 1.19, 95% CI 0.62 to 2.28, p=0.61), cardiovascular hospitalisation (HR 1.02, 95% CI 0.76 to 1.35, p=0.91), stroke/TIA (HR 1.18, 95% CI 0.30 to 4.74, p=0.81) or bleeding-related hospitalisation (HR 1.29, 95% CI 0.66 to 2.52, p=0.45) at 1 year for patients treated with either a NOAC or VKA.ConclusionsCardioversion was a low-risk procedure for patients treated with NOAC, and there were statistically similar rates of stroke/TIA 30 days after cardioversion as for patients treated with VKA. There were no statically significant differences in death, stroke/TIA or major bleeding at 1 year among patients treated with NOAC compared with VKA after cardioversion.
- Subjects :
- Male
medicine.medical_specialty
Time Factors
medicine.medical_treatment
Electric Countershock
Administration, Oral
Cardioversion
Internal medicine
Atrial Fibrillation
medicine
Humans
Stroke
Oral anticoagulation
Aged
Retrospective Studies
medicine.diagnostic_test
business.industry
Incidence
Incidence (epidemiology)
Anticoagulants
Atrial fibrillation
Middle Aged
medicine.disease
United States
Clinical Practice
Cardiology
Female
Cardiology and Cardiovascular Medicine
Cardioversions
business
Electrocardiography
Follow-Up Studies
Subjects
Details
- ISSN :
- 1468201X and 13556037
- Volume :
- 107
- Database :
- OpenAIRE
- Journal :
- Heart
- Accession number :
- edsair.doi.dedup.....773350999b0e3965646616f595801355