Clinical Performance of Apixaban vs. Vitamin K Antagonists in Patients with Atrial Fibrillation Undergoing Direct Electrical Current Cardioversion: A Prospective ... View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2019-03-06

AUTHORS

Anna Rago, Andrea Antonio Papa, Antonio Cassese, Giulia Arena, Maria Cristina Giada Magliocca, Antonio D’Onofrio, Paolo Golino, Gerardo Nigro, Vincenzo Russo

ABSTRACT

INTRODUCTION: Atrial fibrillation (AF) is associated with an increased risk of thromboembolic events. 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. 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. 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%; p = 0.3). 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. More... »

PAGES

1-7

References to SciGraph publications

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URI

http://scigraph.springernature.com/pub.10.1007/s40256-019-00341-9

DOI

http://dx.doi.org/10.1007/s40256-019-00341-9

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1112541206

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/30838557


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