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

O Kalejs; K Jubele; A Strelnieks; I Sime; I Cgojeva-Sproge; G Kamzola; M Berzina; I Mintale; M Vikmane; S Sakne; A Lejnieks; A Erglis

Abstract

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
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.

Original language	English
Article number	19980
Journal	Circulation
Volume	134
Issue number	Suppl.1
Publication status	Published - Nov 2016
Externally published	Yes
Event	Scientific Sessions of the American-Heart-Association / Resuscitation Science Symposium - New Orlean, United States Duration: 12 Nov 2016 → 16 Nov 2016 https://professional.heart.org/en/meetings/resuscitation-science-symposium/archive

Keywords*

Anticoagulants
Atrial fibrillation
Dabigatran
Rivoraxaban
Warfarin

Field of Science*

3.2 Clinical medicine

Publication Type*

3.3. Publications in conference proceedings indexed in Web of Science and/or Scopus database

Access to Document

https://www.ahajournals.org/doi/10.1161/circ.134.suppl_1.19980

Cite this

Kalejs, O., Jubele, K., Strelnieks, A., Sime, I., Cgojeva-Sproge, I., Kamzola, G., Berzina, M., Mintale, I., Vikmane, M., Sakne, S., Lejnieks, A., & Erglis, A. (2016). 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. Circulation, 134(Suppl.1), Article 19980. https://www.ahajournals.org/doi/10.1161/circ.134.suppl_1.19980

@article{50305553cdb642a8be16f1d1be6c276d,

title = "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",

abstract = "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 warfarinMethods: 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, pConclusions: 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.",

keywords = "Anticoagulants, Atrial fibrillation, Dabigatran, Rivoraxaban, Warfarin",

author = "O Kalejs and K Jubele and A Strelnieks and I Sime and I Cgojeva-Sproge and G Kamzola and M Berzina and I Mintale and M Vikmane and S Sakne and A Lejnieks and A Erglis",

year = "2016",

month = nov,

language = "English",

volume = "134",

journal = "Circulation",

issn = "0009-7322",

publisher = "Lippincott Williams and Wilkins Ltd.",

number = "Suppl.1",

note = "Scientific Sessions of the American-Heart-Association / Resuscitation Science Symposium ; Conference date: 12-11-2016 Through 16-11-2016",

url = "https://professional.heart.org/en/meetings/resuscitation-science-symposium/archive",

}

Kalejs, O , Jubele, K , Strelnieks, A, Sime, I, Cgojeva-Sproge, I, Kamzola, G, Berzina, M, Mintale, I, Vikmane, M, Sakne, S, Lejnieks, A & Erglis, A 2016, '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', Circulation, vol. 134, no. Suppl.1, 19980. <https://www.ahajournals.org/doi/10.1161/circ.134.suppl_1.19980>

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. / Kalejs, O ; Jubele, K ; Strelnieks, A et al.
In: Circulation, Vol. 134, No. Suppl.1, 19980, 11.2016.

Research output: Contribution to journal › Meeting Abstract › peer-review

TY - JOUR

T1 - 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

AU - Kalejs, O

AU - Jubele, K

AU - Strelnieks, A

AU - Sime, I

AU - Cgojeva-Sproge, I

AU - Kamzola, G

AU - Berzina, M

AU - Mintale, I

AU - Vikmane, M

AU - Sakne, S

AU - Lejnieks, A

AU - Erglis, A

PY - 2016/11

Y1 - 2016/11

N2 - 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 warfarinMethods: 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, pConclusions: 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.

AB - 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 warfarinMethods: 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, pConclusions: 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.

KW - Anticoagulants

KW - Atrial fibrillation

KW - Dabigatran

KW - Rivoraxaban

KW - Warfarin

UR - https://www-webofscience-com.db.rsu.lv/wos/alldb/full-record/WOS:000396816608017

M3 - Meeting Abstract

SN - 0009-7322

VL - 134

JO - Circulation

JF - Circulation

IS - Suppl.1

M1 - 19980

T2 - Scientific Sessions of the American-Heart-Association / Resuscitation Science Symposium

Y2 - 12 November 2016 through 16 November 2016

ER -