title: Is one month treatment with dabigatran before cardioversion of atrial fibrillation sufficient to prevent thromboembolism?
abstract: OBJECTIVE
  The use of direct oral anticoagulants (DOACs) in patients undergoing elective direct current (DC) cardioversion of non-acute atrial fibrillation (AF) can potentially shorten the time from initiation of anticoagulation treatment to cardioversion, compared with warfarin. The safety of this strategy needs to be investigated. Data from subgroup analysis from clinical trials with DOAC do not clarify whether 4-week treatment with DOAC is sufficient to prevent thromboembolism (TE) after cardioversion. The aim of this retrospective study was to assess the incidence of TE in anticoagulant naive patients converted after one month's pre-treatment with dabigatran.
  
  
  RESULTS
  We scrutinized the medical records of 631 patients where dabigatran had been used prior to elective DC cardioversion. Transoesophageal echocardiography was rarely performed. Thromboembolism within 30 days of cardioversion was the primary endpoint. A total of 570 patients were naive to OAC when dabigatran was initiated. The mean age in this group was 64.2 ± 11 years and 31.7% were women. The mean CHA2DS2-VASc score was 2.0 ± 1.5. The dose of dabigatran was 150 mg b.i.d. in 94% of the patients. The median time from initiation of dabigatran to cardioversion was 32.0 ± 15 days. In 91% cardioversion resulted in sinus rhythm. During the 30-day follow-up, three TE occurred for an incidence of 0.53% (0.18-1.54).
  
  
  CONCLUSIONS
  In this retrospective study from clinical material, we found a low incidence of TE when dabigatran was used as TE prophylaxis in association with elective cardioversion. These results indicate that dabigatran is a safe alternative strategy to warfarin during cardioversion in patients with AF.
authors.affiliation: Department of Clinical Sciences and Education, Södersjukhuset, Karolinska Institutet, 118 83 Stockholm, Sweden anna-karin.e.johansson@sodersjukhuset.se annakarin.ee.johansson@gmail.com.
authors.forename: Anna-Karin
authors.initials: AK
authors.lastname: Johansson
authors.affiliation: Department of Cardiology, Skåne University Hospital, Malmö, Sweden.
authors.forename: Tord
authors.initials: T
authors.lastname: Juhlin
authors.affiliation: Department of Medicine, Halland Hospital, Halmstad, Sweden.
authors.forename: Johan
authors.initials: J
authors.lastname: Engdahl
authors.affiliation: Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Stefan
authors.initials: S
authors.lastname: Lind
authors.affiliation: Department of Clinical Science, Danderyd University Hospital, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Kristina
authors.initials: K
authors.lastname: Hagwall
authors.affiliation: Department of Cardiology, Varberg County Hospital, Varberg, Sweden.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Rorsman
authors.affiliation: Department of Cardiology, Köping County Hospital, Köping, Sweden.
authors.forename: Emöke
authors.initials: E
authors.lastname: Fodor
authors.affiliation: Department of Cardiology, Västerås Central Hospital, Västerås, Sweden.
authors.forename: Anna
authors.initials: A
authors.lastname: Alenholt
authors.affiliation: Department of Clinical Sciences and Education, Södersjukhuset, Karolinska Institutet, 118 83 Stockholm, Sweden.
authors.forename: Astrid
authors.initials: A
authors.lastname: Paul Nordin
authors.affiliation: Department of Clinical Science, Danderyd University Hospital, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Mårten
authors.initials: M
authors.lastname: Rosenqvist
authors.affiliation: Department of Clinical Sciences and Education, Södersjukhuset, Karolinska Institutet, 118 83 Stockholm, Sweden.
authors.forename: Mats
authors.initials: M
authors.lastname: Frick
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D001281:Atrial Fibrillation / Q000628:therapy*; D000069604:Dabigatran / Q000008:administration & dosage* / Q000009:adverse effects; D004554:Electric Countershock; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013923:Thromboembolism / Q000453:epidemiology / Q000517:prevention & control*; D014859:Warfarin / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D014859:Warfarin; D000069604:Dabigatran
keywords: Anticoagulation; Apixaban; Atrial fibrillation; Cardioversion; Dabigatran; Rivaroxaban; Stroke; Thromboembolism; Warfarin