title: The Efficacy and Safety of Oral Rivaroxaban in Patients with Non-Valvular Atrial Fibrillation Scheduled for Electrical Cardioversion.
abstract: Objective Electrical cardioversion (EC) is associated with an increased risk of thrombotic events in patients with non-valvular atrial fibrillation (NVAF). Patients who experience AF for a period of >48 hours therefore require adequate anticoagulation therapy for at least 3 weeks before and 4 weeks after EC. While the guidelines address the management of vitamin K antagonists (VKAs), there are limited data on the use of novel oral anticoagulants (NOAC). One NOAC, rivaroxaban, has a rapid onset of action and might therefore shorten the time for which anti-coagulant treatment is required before a patient undergoes EC. Methods This study included 91 patients with NVAF of >48 hours in duration or in whom the time of onset was unknown who were undergoing EC after pretreatment with rivaroxaban. All of the patients were pretreated with rivaroxaban for at least 2 hours before EC and the same dose of rivaroxaban was prescribed for 4 weeks after EC. The primary endpoint was a successful EC without any thrombotic events or bleeding complications within 30 days after EC. The secondary endpoint was the time to EC. Results The mean age was 63±12 years and 70 of the 91 patients were male. The CHADS2 and HAS-BLED scores were 1.0±1.0 and 1.7±1.3, respectively. Although there were no thrombotic events, minor bleeding (gingival hemorrhage) occurred 20 days after the initiation of rivaroxaban treatment in one patient. The average time to EC was 11.9±11.1 days. Conclusion Rivaroxaban is safe and effective drug for NVAF patients who are scheduled for an EC. Furthermore, since VKAs take a substantial amount of time to establish adequate anticoagulation, pretreatment with rivaroxaban could shorten the time to the EC.
authors.affiliation: Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Japan.
authors.forename: Yoshinari
authors.initials: Y
authors.lastname: Enomoto
authors.forename: Naoshi
authors.initials: N
authors.lastname: Ito
authors.forename: Tadashi
authors.initials: T
authors.lastname: Fujino
authors.forename: Mahito
authors.initials: M
authors.lastname: Noro
authors.forename: Takanori
authors.initials: T
authors.lastname: Ikeda
authors.forename: Kaoru
authors.initials: K
authors.lastname: Sugi
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000628:therapy*; D004554:Electric Countershock / Q000379:methods*; D065427:Factor Xa Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012306:Risk; D000069552:Rivaroxaban / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D065427:Factor Xa Inhibitors; D000069552:Rivaroxaban