Direct Current Cardioversion in Atrial Fibrillation Patients on Edoxaban Therapy Versus Vitamin K Antagonists: a Real-wo
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ORIGINAL ARTICLE
Direct Current Cardioversion in Atrial Fibrillation Patients on Edoxaban Therapy Versus Vitamin K Antagonists: a Real-world Propensity Score–Matched Study Anna Rago 1 & Andrea Antonio Papa 1 Gerardo Nigro 1 & Vincenzo Russo 1
&
Emilio Attena 2 & Valentina Parisi 3 & Paolo Golino 1 &
Accepted: 10 September 2020 # The Author(s) 2020
Abstract Purpose The purpose of the present study was to compare the long-term effectiveness and safety of newly initiated anticoagulation with edoxaban (EDO) versus uninterrupted vitamin K antagonist (VKA) therapy in patients with atrial fibrillation (AF) scheduled for transesophageal echocardiogram (TEE)-guided direct electrical current cardioversion (DCC). Methods A propensity score-matched cohort observational study was performed comparing the safety and effectiveness of edoxaban versus well-controlled VKA therapy among a cohort of consecutive non-valvular AF patients scheduled for DCC. The primary safety outcome was major bleeding. The primary efficacy outcome was the composite of stroke, transient ischemic attack (TIA), and systemic embolism (SE). Findings A total of 130 AF patients receiving edoxaban 60-mg (EDO) treatment were compared with the same number of VKA recipients. The cumulative incidence of major bleedings was 1.54% in the EDO group and 3.08% in the VKA group (P = 0.4). The cumulative incidence of thromboembolic events was 1.54% in the EDO group and 2.31% in the VKA group (P = 0.9). A non-significant trend in improved adherence was observed between the EDO and VKA groups with a total anticoagulant therapy discontinuation rate of 4.62% (6/130) vs 6.15% (8/130), respectively (P = 0.06). Implications Our study provides the evidence of a safe and effective use of edoxaban in this clinical setting, justified by no significant difference in major bleedings and thromboembolic events between edoxaban and well-controlled VKA treatments. Keywords Atrial fibrillation . Transesophageal echocardiogram . Direct electrical current cardioversion . Edoxaban . Uninterrupted vitamin K antagonists
Introduction Cardioversion (both electric and pharmacological) in AF patients is associated with an increased risk of thromboembolic events [1, 2] and an adequate level of periprocedural anticoagulation is essential to reduce this risk. The use of direct oral anticoagulants (DOACs) in clinical practice is rapidly
* Andrea Antonio Papa [email protected] 1
University of the Study of Campania “Luigi Vanvitelli” – Monaldi Hospital, P.zzale E. Ruggeri, 80131 Naples, Italy
2
Department of Cardiology, Health Authority Naples, Naples, Italy
3
Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
increasing [3–9], even in the setting of patients with AF undergoing electrical cardioversion [10–13], and the current guidelines recommend initiating anticoagulation with DOACs as soon as possible before every cardioversion of AF [14, 15]. For patients with AF of > 48-h duration, the current recommendation is to start oral anticoagul
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