Outcomes After Cardioversion in Atrial Fibrillation Patients Treated with Non-Vitamin K Antagonist Oral Anticoagulants (NOACs): Insights from a Meta-Analysis

Background: There are limited data on outcomes following cardioversion in atrial fibrillation (AF) patients treated with non-vitamin K antagonist oral anticoagulants (NOACs). A meta-analysis was performed to evaluate the efficacy and safety of NOACs in patients with AF undergoing cardioversion. Methods: PubMed, Cochrane Library, EMBASE, Web of Science and CINAHL databases were searched from January 1, 2001 through to October 30, 2014. Randomized controlled trials (RCTs) comparing NOACs (apixaban, rivaroxaban and dabigatran) with warfarin in AF patients undergoing cardioversion were selected. The primary efficacy outcome was stroke and systemic embolism, and the primary safety outcome was major or clinically relevant non-major (CRNM) bleeding. We used random-effects models. Results: Four RCTs were included, involving a total of 3635 randomized participants who underwent a total of 4257 cardioversions. A total of 12 events of stroke and systemic embolism were found in the NOAC group and ten events in the warfarin group [odds ratio (OR) 0.73, 95 % confidence interval (CI) 0.31–1.72]. Risk of major or CRNM bleeding was not different with NOACs, when compared with warfarin (OR 1.41, 95 % CI 0.87–2.28). Conclusions: Data from patients enrolled in RCTs, showed that NOACs are effective and safe for AF patients undergoing cardioversion.