title: Non-vitamin K antagonist oral anticoagulants in the cardioversion of patients with atrial fibrillation: systematic review and meta-analysis.
abstract: BACKGROUND
  Non-vitamin K antagonist oral anticoagulants (NOACs) are at least non-inferior to Vitamin K Antagonists (VKAs) for stroke prevention on patients with non-valvular atrial fibrillation (AF). We aimed to evaluate the efficacy and safety of NOACs in patients undergoing cardioversion through a systematic review and meta-analysis.
  
  
  METHODS
  MEDLINE, Cochrane Library, and Web of Science(®) databases (until September 2014) were searched for studies fulfilling inclusion criteria. Two reviewers independently selected randomized controlled trials (RCTs) evaluating NOACs and VKA in patients with AF undergoing cardioversion. The primary outcome was ischemic stroke or systemic embolism (IS/SE). Secondary outcomes were major bleeding, myocardial infarction, and mortality. Risk ratio (RR) and 95 % confidence intervals were derived through random-effects meta-analysis. Heterogeneity was evaluated through I (2) test.
  
  
  RESULTS
  Four RCTs (3 post-hoc analysis) evaluating apixaban, dabigatran, and rivaroxaban in 3,512 patients with AF were included. The risk of IS/SE with NOACs was similar to VKA (RR 0.60, 95 % CI 0.20-1.80; I (2) = 17 %). There was no significant increase in major bleeding (RR 1.27, 95 % CI 0.58-2.81; I (2) = 0 %), myocardial infarction (RR 0.71, 95 % CI 0.10-5.04; I (2) = 0 %), or mortality (RR 0.87, 95 % CI 0.24-3.08; I (2) = 0 %) with NOACs.
  
  
  CONCLUSIONS
  This systematic review and meta-analysis suggests that NOACs may be as safe as VKAs in the setting of AF cardioversion.
authors: Clinical Pharmacology Unit, Instituto de Medicina Molecular, Lisbon, Portugal, dgcaldeira@hotmail.com.
authors: Daniel
authors: D
authors: Caldeira
authors: João
authors: J
authors: Costa
authors: Joaquim J
authors: JJ
authors: Ferreira
authors: Gregory Y H
authors: GY
authors: Lip
authors: Fausto J
authors: FJ
authors: Pinto
mesh_terms: D000284:Administration, Oral; D000925:Anticoagulants / Q000008:administration & dosage*; D001281:Atrial Fibrillation / Q000401:mortality* / Q000517:prevention & control*; D015984:Causality; D015897:Comorbidity; D017147:Defibrillators, Implantable / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D012307:Risk Factors; D020521:Stroke / Q000401:mortality* / Q000517:prevention & control*; D015996:Survival Rate; D016896:Treatment Outcome; D014812:Vitamin K / Q000037:antagonists & inhibitors
chemical_list: D000925:Anticoagulants; D014812:Vitamin K
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