Details

Autor(en) / Beteiligte

• Troisi, Federica
• Guida, Pietro
• Vitulano, Nicola
• Quadrini, Federico
• Di Monaco, Antonio
• Grimaldi, Massimo

Titel

Safety and efficacy of direct oral anticoagulants versus vitamin K antagonists in atrial fibrillation electrical cardioversion: An update systematic review and meta-analysis

Ist Teil von

• International journal of cardiology, 2023-05, Vol.379, p.40-47

Ort / Verlag

Netherlands: Elsevier B.V

Erscheinungsjahr

2023

Link zum Volltext

Quelle

MEDLINE

Beschreibungen/Notizen

• A systematic evaluation focused on efficacy and safety for electrical cardioversion of atrial fibrillation (AF) among different Direct Oral Anticoagulants (DOACs) has not been previously performed. In this setting, we conducted a meta-analysis of studies evaluating DOACs vs vitamin K antagonists (VKA) as common comparator. We searched Cochrane Library, Pubmed, Web Of Science and Scopus databases for all English-only articles concerning studies that have estimated the effect of DOACs and VKA on stroke, transient ischemic attack or systemic embolism (SSE) and major bleeding (MB) events in AF patients undergoing electrical cardioversion. We selected 22 articles comprising 66 cohorts and 24,322 procedures (12,612 with VKA). During follow-up (studies' median 42 days), 135 SSE (52 DOACs and 83 VKA) and 165 MB (60 DOACs and 105 VKA) were recorded. The overall pooled effects, DOACs vs VKA, was estimated by an univariate Odds Ratio of 0.92 (0.63–1.33; p = 0.645) for SSE and 0.58 (0.41–0.82; p = 0.002) for MB; at bivariate evaluation, adjusting for study type, were respectively 0.94 (0.55–1.63; p = 0.834) and 0.63 (0.43–0.92, p = 0.016). Each single DOAC showed similar and non statistically different results in outcome occurrence compared to VKA as well as when Apixaban, Dabigatran, Edoxaban and Rivaroxaban were indirectly compared to each other. In patients undergoing electrical cardioversion, compared to VKA, DOACs have similar thromboembolic protection with lower major bleeding incidence. Single molecule does not show difference in event rate compared to each other. Our findings, provide useful information about safety and efficacy profile of DOACs and VKA. •Direct Oral Anticoagulants (DOACs) have entered in clinical practice for a decade.•Vitamin K antagonists (VKA) is the traditional oral anticoagulant therapy.•Cardioversion for atrial fibrillation requires a therapeutic anticoagulation.•Efficacy and safety of DOACs vs VKA were compared by meta-analysis of 22 studies.•Thromboembolic protection and major bleeding were not different among molecules.