Non Vitamin K Antagonist Oral Anticoagulants in Atrial Fibrillation Patients Scheduled for Electrical Cardioversion: A Real-Life Propensity Score Matched Study

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 showed a safe and effective clinical profile of NOACs among AF patients scheduled for electrical cardioversion in real-life setting. Patients on NOACs therapy showed a lower discontinuation rate compared to those on VKAs.Keywords: atrial fibrillation, electrical cardioversion, transesophageal echocardiogram, non-vitamin K antagonist oral anticoagulants, discontinuation rate, vitamin K antagonists