NOACs a "reasonable" alternative to VKAs in cardioversion patients

By Lorraine L. Janeczko

NEW YORK (Reuters Health) - In non-valvular atrial fibrillation patients undergoing cardioversion, non-vitamin K oral anticoagulants (NOACs) appear to be as effective and safe as vitamin K antagonists (VKAs), according to a new meta-analysis from Italy.

As Dr. Giulia Renda told Reuters Health by phone, "NOACs carried similar short-term risk of thromboembolism and major bleeding in the early period after cardioversion."

"All four available NOACs are as effective and safe as warfarin in these patients," added Dr. Renda of "G. d'Annunzio" University in Chieti.

The findings were published online October 14 in The American Journal of Medicine.

Dr. Renda and her colleagues performed a random-effects meta-analysis of patients undergoing both electrical and pharmacological cardioversion for AF in the RE-LY, ROCKET-AF, ARISTOTLE, ENGAGE AF-TIMI 48, X-VeRT and ENSURE-AF trials.

Based on data from more than 6,100 patients, NOACs did not carry a higher risk of stroke/systemic embolism (risk ratio, 0.82; 95% CI: 0.38-1.75) or major bleeding (RR, 0.98; 95% CI: 0.51-1.87) than did VKAs.

The researchers found no significant heterogeneity among studies.

"The opportunity to achieve a faster and more stable control of anticoagulation in patients needing cardioversion is an unquestionable theoretical and practical advantage in terms of time to procedure and patients' safety," the team writes.

"Moreover," they add, "NOACs may be useful when immediate cardioversion is required due to patient hemodynamic instability, or with AF lasting

The authors caution that the analysis may be underpowered to detect minor differences between the tested treatments.

The study had no funding. Dr. Renda and one other author declared financial relationships with various drug companies.

SOURCE: https://bit.ly/2ekR0Ay

Am J Med 2016.