Anna-Karin Johansson1, Tord Juhlin2, Johan Engdahl3, Stefan Lind4, Kristina Hagwall5, Cecilia Rorsman6, Emöke Fodor7, Anna Alenholt8, Astrid Paul Nordin9, Mårten Rosenqvist5, Mats Frick9. 1. Department of Clinical Sciences and Education, Södersjukhuset, Karolinska Institutet, 118 83 Stockholm, Sweden anna-karin.e.johansson@sodersjukhuset.se annakarin.ee.johansson@gmail.com. 2. Department of Cardiology, Skåne University Hospital, Malmö, Sweden. 3. Department of Medicine, Halland Hospital, Halmstad, Sweden. 4. Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden. 5. Department of Clinical Science, Danderyd University Hospital, Karolinska Institutet, Stockholm, Sweden. 6. Department of Cardiology, Varberg County Hospital, Varberg, Sweden. 7. Department of Cardiology, Köping County Hospital, Köping, Sweden. 8. Department of Cardiology, Västerås Central Hospital, Västerås, Sweden. 9. Department of Clinical Sciences and Education, Södersjukhuset, Karolinska Institutet, 118 83 Stockholm, Sweden.
Abstract
AIMS: The use of direct oral anticoagulants (DOACs) in patients undergoing elective direct current (DC) cardioversion of non-acute atrial fibrillation (AF) can potentially shorten the time from initiation of anticoagulation treatment to cardioversion, compared with warfarin. The safety of this strategy needs to be investigated. Data from subgroup analysis from clinical trials with DOAC do not clarify whether 4-week treatment with DOAC is sufficient to prevent thromboembolism (TE) after cardioversion. The aim of this retrospective study was to assess the incidence of TE in anticoagulant naive patients converted after one month's pre-treatment with dabigatran. METHODS AND RESULTS: We scrutinized the medical records of 631 patients where dabigatran had been used prior to elective DC cardioversion. Transoesophageal echocardiography was rarely performed. Thromboembolism within 30 days of cardioversion was the primary endpoint. A total of 570 patients were naive to OAC when dabigatran was initiated. The mean age in this group was 64.2 ± 11 years and 31.7% were women. The mean CHA2DS2-VASc score was 2.0 ± 1.5. The dose of dabigatran was 150 mg b.i.d. in 94% of the patients. The median time from initiation of dabigatran to cardioversion was 32.0 ± 15 days. In 91% cardioversion resulted in sinus rhythm. During the 30-day follow-up, three TE occurred for an incidence of 0.53% (0.18-1.54). CONCLUSION: In this retrospective study from clinical material, we found a low incidence of TE when dabigatran was used as TE prophylaxis in association with elective cardioversion. These results indicate that dabigatran is a safe alternative strategy to warfarin during cardioversion in patients with AF. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: The use of direct oral anticoagulants (DOACs) in patients undergoing elective direct current (DC) cardioversion of non-acute atrial fibrillation (AF) can potentially shorten the time from initiation of anticoagulation treatment to cardioversion, compared with warfarin. The safety of this strategy needs to be investigated. Data from subgroup analysis from clinical trials with DOAC do not clarify whether 4-week treatment with DOAC is sufficient to prevent thromboembolism (TE) after cardioversion. The aim of this retrospective study was to assess the incidence of TE in anticoagulant naive patients converted after one month's pre-treatment with dabigatran. METHODS AND RESULTS: We scrutinized the medical records of 631 patients where dabigatran had been used prior to elective DC cardioversion. Transoesophageal echocardiography was rarely performed. Thromboembolism within 30 days of cardioversion was the primary endpoint. A total of 570 patients were naive to OAC when dabigatran was initiated. The mean age in this group was 64.2 ± 11 years and 31.7% were women. The mean CHA2DS2-VASc score was 2.0 ± 1.5. The dose of dabigatran was 150 mg b.i.d. in 94% of the patients. The median time from initiation of dabigatran to cardioversion was 32.0 ± 15 days. In 91% cardioversion resulted in sinus rhythm. During the 30-day follow-up, three TE occurred for an incidence of 0.53% (0.18-1.54). CONCLUSION: In this retrospective study from clinical material, we found a low incidence of TE when dabigatran was used as TE prophylaxis in association with elective cardioversion. These results indicate that dabigatran is a safe alternative strategy to warfarin during cardioversion in patients with AF. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Vincenzo Russo; Anna Rago; Andrea Antonio Papa; Antonio D'Onofrio; Paolo Golino; Gerardo Nigro Journal: J Thromb Thrombolysis Date: 2018-02 Impact factor: 2.300