Abstract 19980: Comparison of Dabigatran and Rivaroxaban versus Warfarin in Patients With Persistent and Long-Standing Atrial Fibrillation Undergoing Electrical Cardioversion With High Risk of Stroke And Embolism
Introduction: The important factor for efficacy and safety for patients (pts) with atrial fibrillation (AF) undergoing electrical cardioversion (ECV) is appropriate use of oral anticoagulant (OAC).
Hypothesis: Novel anticoagulants (NOAC) are a possible alternative OAC before and after ECV versus warfarin
Methods: We have analysed the data before and after ECV in 2215 pts undergoing ECV. All pts had AF, 1718 persistent and 497 defined as long-standing, CHA2 DS2 VASc score was 3.6 ± 1.8, 1578 had one or two ECV previously. 1431 (64.6%) pts started the use of NOAC: dabigatran 490 pts 150 mg twice or 344 pts 110 mg twice or 597 rivaroxaban 20 mg daily before ECV for at least 21 day, 748 (35.4%) started warfarin therapy and 21 day start after INR was in range 2.0 - 3.0. 110 mg twice were prescribed for pts ≥ 75 year, HASBLEED ≥3 and chronic kidney disease. Transesophageal echocardiography (TEE) was encouraged before ECV in all pts with CHA2DS2VASc score ≥ 4, left atrial (LA) dilatation and AF duration ≥ 6 months. ECG and ECHO data were analysed 30, 90 and 180 days after ECV.
Results: ECV was successful after first shock in 2049 (92.5 %) pts, total success ECV 2175 (98.2%) pts. LA thrombi were detected on TEE before ECV in 76 pts in NOAC and 52 pts in warfarin group, so, pts continued OAC for two months, and TEE had been performed again after. 12 pts in dabigatran (150 mg twice), 11 pts in rivaroxaban (20 mg od) and 11 pts in warfarin group were free of thrombus and have been referred to ECV. Average time before ECV was significantly lower for NOAC (25 days) vs warfarin (48 days, p<0.01). Stroke and embolism rates at 90 days were lower in NOAC (0.3%) vs warfarin group (1.7%), but the two events in NOAC group was after discontinuation of the drug while 10 warfarin events were detected under the time of use. NOAC pts had significantly lower clinical relevant bleeding rate vs warfarin (D 110 mg 0, D 150 mg 0.61%, R 0.34% vs W 2.94%, p<0.04).
Conclusions: Rivaroxaban 20 mg daily and dabigatran 150 mg and 110 mg twice are a safe, effective and reasonable alternative to warfarin for patients undergoing ECV despite high CHA2DS2VASc risk, HASBLEED and AF duration. The frequencies of stroke and embolism were lower in dabigatran 150 mg and 110 mg and rivaroxaban 20 mg versus warfarin with lower bleeding within 30 and 90 days after ECV.
Author Disclosures: O. Kalejs: None. K. Jubele: None. A. Strelnieks: None. I. Sime: None. I. Cgojeva-Sproge: None. G. Kamzola: None. M. Berzina: None. I. Mintale: None. M. Vikmane: None. S. Sakne: None. A. Lejnieks: None. A. Erglis: None.
- © 2016 by American Heart Association, Inc.