Anna Rago1, Andrea Antonio Papa2, Antonio Cassese1, Giulia Arena3, Maria Cristina Giada Magliocca4, Antonio D'Onofrio5, Paolo Golino1, Gerardo Nigro1, Vincenzo Russo1. 1. Chair of Cardiology, University of the Study of Campania "Luigi Vanvitelli"-Monaldi Hospital, Naples, Italy. 2. Chair of Cardiology, University of the Study of Campania "Luigi Vanvitelli"-Monaldi Hospital, Naples, Italy. andreaantoniopapa@libero.it. 3. Cardiology Department, "Ospedale del Mare", Naples, Italy. 4. Anesthesia Department, Moscati Hospital, Aversa, Caserta, Italy. 5. Departmental Unit of Electrophysiology, Evaluation and Treatment of Arrhythmias, Monaldi Hospital, Naples, Italy.
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.
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.
Authors: Francesco De Sensi; Gennaro Miracapillo; Luigi Addonisio; Marco Breschi; Alberto Cresti; Pasquale Baratta; Francesco Paneni; Ugo Limbruno Journal: Medicina (Kaunas) Date: 2019-08-20 Impact factor: 2.430
Authors: Anna Rago; Enrica Pezzullo; Marco Malvezzi Caracciolo d'Aquino; Gabriella Scognamiglio; Valentina Maria Caso; Francesco Martone; Emilio Attena; Valentina Parisi; Antonio D'Onofrio; Paolo Golino; Gerardo Nigro; Vincenzo Russo Journal: J Blood Med Date: 2021-06-04