title: Outcomes After Cardioversion in Atrial Fibrillation Patients Treated with Non-Vitamin K Antagonist Oral Anticoagulants (NOACs): Insights from a Meta-Analysis.
abstract: 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.
authors.affiliation: Department of Medicine, St. Michael's Medical Center, Newark, NJ, USA. parijatsenstation@gmail.com.
authors.forename: Parijat
authors.identifier: http://orcid.org/0000-0002-5764-358X
authors.initials: P
authors.lastname: Sen
authors.affiliation: Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA.
authors.forename: Amartya
authors.initials: A
authors.lastname: Kundu
authors.affiliation: Department of Cardiology, University of Utah, Salt Lake City, Utah, USA.
authors.forename: Partha
authors.initials: P
authors.lastname: Sardar
authors.affiliation: St Luke's Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, NY, USA.
authors.forename: Saurav
authors.initials: S
authors.lastname: Chatterjee
authors.affiliation: Department of Cardiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
authors.forename: Ramez
authors.initials: R
authors.lastname: Nairooz
authors.affiliation: Department of Medicine, New York Medical College-Metropolitan Hospital Center, New York, NY, USA.
authors.forename: Hossam
authors.initials: H
authors.lastname: Amin
authors.affiliation: Division of Cardiology, New York Medical College, Valhalla, NY, USA.
authors.forename: Wilbert S
authors.initials: WS
authors.lastname: Aronow
mesh_terms: D000284:Administration, Oral; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000150:complications / Q000628:therapy*; D004554:Electric Countershock / Q000379:methods*; D004617:Embolism / Q000209:etiology / Q000517:prevention & control; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D020521:Stroke / Q000209:etiology / Q000517:prevention & control
chemical_list: D000925:Anticoagulants