"Non-vitamin K antagonists oral anticoagulants are as safe and effectiv" by Nelson Telles-Garcia, Khagendra Dahal et al.

Faculty Publications

Title

Non-vitamin K antagonists oral anticoagulants are as safe and effective as warfarin for cardioversion of atrial fibrillation: A systematic review and meta-analysis

Authors

Nelson Telles-Garcia, Division of Cardiology, Department of Medicine, Louisiana State University Health Sciences Center, Shreveport, LA, United States.
Khagendra Dahal, Division of Cardiology, Department of Medicine, Louisiana State University Health Sciences Center, Shreveport, LA, United States.
Cyrus Kocherla, Division of Cardiology, Department of Medicine, Louisiana State University Health Sciences Center, Shreveport, LA, United States.
Gregory Y. Lip, Institute of Cardiovascular Sciences, University of Birmingham, United Kingdom; Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
Pratap Reddy, Division of Cardiology, Department of Medicine, Louisiana State University Health Sciences Center, Shreveport, LA, United States.
Paari Dominic, Division of Cardiovascular Medicine, Louisiana State University Health Science Center, Shreveport, LA, USA. Electronic address: pdomi2@lsuhsc.edu.

Document Type

Article

Publication Date

10-1-2018

Abstract

BACKGROUND: Current guidelines recommend anticoagulation using warfarin with bridging parenteral anticoagulation or one of the non-vitamin K antagonist oral anticoagulants (NOACs) to prevent thromboembolic events in patients undergoing cardioversion for atrial fibrillation (AF). We aimed to compare by meta-analytical techniques, the safety and efficacy of NOACs versus warfarin in patients undergoing cardioversion. METHODS: PUBMED, EMBASE, Cochrane CENTRAL and CINAHL were searched electronically in addition to manual search for randomized controlled trials (RCTs) comparing NOACs and warfarin in patients undergoing cardioversion for AF. Mortality, major bleeding and ischemic and hemorrhagic stroke were compared between the two agents. RESULTS: A total of 7 trials with 7588 total patients were included in the meta-analysis. NOACs, as compared to warfarin, resulted in similar risk of ischemic stroke [odds ratio (OR): 0.49 (95% confidence interval (CI): 0.20-1.19; P = 0.12], major bleeding [0.71 (0.37-1.38), P = 0.32], mortality [0.73 (0.32-1.67); P = 0.45], and hemorrhagic stroke [0.96 (0.11-8.70); P = 0.97]. The results were consistent across subgroup analyses. CONCLUSIONS: Based on the current meta-analysis, NOACs and warfarin have comparable efficacy and safety in patients with atrial fibrillation undergoing cardioversion.

Publication Source (Journal or Book title)

International journal of cardiology

First Page

143

Last Page

148

Recommended Citation

Telles-Garcia, N., Dahal, K., Kocherla, C., Lip, G. Y., Reddy, P., & Dominic, P. (2018). Non-vitamin K antagonists oral anticoagulants are as safe and effective as warfarin for cardioversion of atrial fibrillation: A systematic review and meta-analysis. International journal of cardiology, 268, 143-148. https://doi.org/10.1016/j.ijcard.2018.04.034

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