Efficacy and Safety of Apixaban in Patients Following Cardioversion for Atrial Fibrillation: Insights from the ARISTOTLE trial.

University of Missouri, Columbia, MO. Electronic address: .
Journal of the American College of Cardiology (Impact Factor: 15.34). 10/2013; 63(11). DOI: 10.1016/j.jacc.2013.09.062
Source: PubMed

ABSTRACT To determine the risk of major clinical and thromboembolic events after cardioversion for atrial fibrillation in subjects treated with apixaban, an oral factor Xa inhibitor compared with warfarin.
In patients with atrial fibrillation (AF), thromboembolic events may occur after cardioversion. This risk is lowered with vitamin K antagonists and dabigatran.
Using data from ARISTOTLE, we conducted a post-hoc analysis of patients undergoing cardioversion.
A total of 743 cardioversions in 540 patients were performed: 265 first cardioversions in patients assigned to apixaban and 275 in those receiving warfarin. The mean time to the first cardioversion for patients assigned to warfarin and apixaban was 243 + 231 and 251 + 248 days respectively; 75% of the cardioversions occurred by 1 year. Baseline characteristics were similar between groups. In patients undergoing cardioversion, no stroke or systemic emboli occurred in the 30 day follow-up period. MI occurred in 1 patient (0.2%) receiving warfarin and 1 receiving apixaban (0.3%). Major bleeding occurred in 1 patient (0.2%) receiving warfarin and 1 receiving apixaban (0.3%). Death occurred in 2 patients (0.5%) receiving warfarin and 2 patients receiving apixaban (0.6%).
Major cardiovascular events after cardioversion of AF are rare and comparable between warfarin and apixaban.

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