2016


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2016/№6

Comparative efficacy of warfarin and new oral anticoagulants in preparing patients with persistent, non-valvular atrial fibrillation for restoration of sinus rhythm

Mazur V. V., Savinkova E. A., Orlov Yu. A., Mazur E. S.
Federal State Budgetary Educational Institution of Higher Education, "Tver State Medical University" of the Ministry of Health of the Russian Federation, Sovetskaya str. 4, Tver 170100

Keywords: atrial fibrillation, new oral anticoagulants, transesophageal echocardiography, cardioversion

DOI: 10.18087/rhj.2016.6.2116

Background. Clinical significance of atrial fibrillation (AF) is related primarily with its thromboembolic complications. The probability of thromboembolic complications increases during cardioversion. Aim. To compare the incidence of detecting contraindications for cardioversion (left atrial appendage thrombosis or high-degree spontaneous echocontrast) using transesophageal EchoCG in patients with persistent, non-valvular AF receiving pre-cardioversion therapy with warfarin and new oral anticoagulants (NOACs) (dabigatran and rivaroxaban). Materials and methods. Transesophageal EcoCG was performed for 208 patients with persistent, non-valvular AF; during preparation for cardioversion, 140 of them received warfarin and 68 received NOACs). Results. The anticoagulant preparation was considered inadequate for patients receiving warfarin and only for 38.6% of patients receiving NOACs. When the anticoagulant preparation was adequate, contraindications for cardioversion were identified in 16.3% of patients receiving warfarin and 9.5% of patients receiving NOACs. Among patients receiving inadequate anticoagulant therapy, contraindications for cardioversion were identified in 37.3 % of cases. Conclusion. Using NOACs 7.91 times decreased the probability of inadequate anticoagulant therapy. With the adequate NOAC therapy, the probability of remaining contraindications for cardioversion was 2.9 times lower than with the adequate warfarin therapy.
  1. Arnold AZ, Mick MJ, Mazurek RP, Loop FD, Trohman RG. Role prophylactic anticoagulation for direct current cardioversion in patients with atrial fibrillation or atrial flatter. J Am Coll Cardiol. 1992 Mar 15;19 (4):851–5.
  2. Camm AJ, Kirkhof P, Lip GY, Schotten U, Savelieva I, Ernst S et al. Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation the European Society of Cardiology (ESC). Eur Heart J. 2010 Oct;31 (19):2369–429.
  3. Seidl K, Rameken M, Drogemuller A, Vater M, Brandt A, Schwacke H et al. Embolic events in patients with atrial fibrillation effective anticoagulation: value of transesophageal echocardiography to guide direct-current cardioversion. Final results of the Ludwigshafen Observational Cardioversion Study. J Am Coll Cardiol. 2002 May 1;39 (9):1436–42.
  4. Zabalgoitia M, Halperin JL, Pearce LA, Blackhear JL, Asinger RW, Hart RG. Transesophageal echocardiographic correlates of clinical risk of thromboembolism in nonvalvular atrial fibrillation. J Am Coll Cardiol. 1998 Jun;31 (7):1622–6.
  5. The Stroke Prevention in Atrial Fibrillation Investigators Committee. Transesophageal echocardiographic correlates of thromboembolism in high-risk patients with nonvalvular atrial fibrillation. Ann Intern Med. 1998 Apr 15;128 (8):639–47.
  6. Maltagliati A, Galli CA, Tamborini G, Celeste F, Muratori M, Pepi M. Incidence of spontaneous echocontrast, “sludge” and thrombi before cardioversion in patients with atrial fibrillation: new insights into the role of transesophageal echocardiography. J Cardiovasc Med (Hagerstown). 2009 Jul;10 (7):523–8.
  7. Camm AJ, Lip GY, De Caterina R , Savelieva I, Atar D, Hohnloser SH et al. 2012 focused update of the ESC Guidelines for the management of atrial fibrillation: an update of the 2010 ESC Guidelines for the management of atrial fibrillation – developed with the special contribution of the EHRA. Europace. 2012 Oct;14 (10):1385–413.
  8. Nagarakanti R , Ezerowitz MD, Oldgren J, Yang S, Chernick M, Aikens TH et al. Dabigatran versus warfarin in patients with atrial fibrillation: an analysis of patients undergoing cardioversion. Circulation. 2011 Jan 18;123 (2):131–6.
  9. January CT, Wann LS, Alpert JS, Calkins H, Cigarroa JE, Cleveland JC Jr et al. 2014 AHA/ACC/HRS Guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol. 2014 Dec 2;64 (21):e1–76.
  10. Piccini JP, Stevens SR , Lokhnigina Y, Patel MR , Halperin JL, Singer DE et al. Outcomes after cardioversion and atrial fibrillation ablation in patients treated with rivaroxaban and warfarin in the ROCKET AF trial. J Am Coll Cardiol. 2013 May 14;61 (19):1998–2006.
  11. Flaker G, Lopes RD, Al-Khatib SM, Hermosillo AG, Hohnloser SH, Tinga B et al. Efficacy and safety of apixaban in patients following cardioversion for atrial fibrillation: insights from the ARISTOTLE trial (Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation). J Am Coll Cardiol. 2014 Mar 25;63 (11):1082–7.
  12. Fatkin D, Kelly RP, Feneley MP. Relations between left atrial appendage blood flow velocity, spontaneous echocardiographic contrast and thromboembolic risk in vivo. J Am Coll Cardiol. 1994 Mar 15;23 (4):961–9.
  13. Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L et al. Recommendations for cardiac camber quantification by echocardiography in adult: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2015 Jan;28 (1):1–39.e14.
  14. Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA et al. Recommendations for camber quantification: a report from the American Society of Echocardiography`s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr. 2005 Dec;18 (12):1440–63.
  15. Nagueh SF, Appleton CP, Gillebert TC, Marino PN, Oh JK, Smiseth OA et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography. Eur J Echocardiogr. 2009 Mar;10 (2):165–93.
  16. Sohn DW, Song JM, Zo JH, Chai IH, Kim HS, Chun HG, Kim HC. Mitral annulus velocity in the evaluation of left ventricular diastolic function in atrial fibrillation. J Am Soc Echocardiogr. 1999 Nov;12 (11):927–31.
  17. Машина Т.В., Голухова Е.З. Диастолическая дисфункция левого желудочка у больных с фибрилляцией предсердий: патогенетические механизмы и современные ультразвуковые методы оценки (аналитический обзор). Креативная кардиология. 2014;4:43–52 [Mashina T.V., Goluxova E.Z. Diastolicheskaya disfunkcziya levogo zheludochka u bol`ny`x s fibrillyacziej predserdij: patogeneticheskie mexanizmy` i sovremenny`e ul`trazvukovy`e metody` oczenki (analiticheskij obzor). Kreativnaya kardiologiya. 2014;4:43–52].
  18. Nagueh SF, Kopelen HA, Quinones MA. Assessment of left ventricular filling pressures by Doppler in presence of atrial fibrillation. Circulation. 1996 Nov 1; (9499):2138–45.
Mazur V.V., Savinkova E.A., Orlov Yu.A., Mazur E.S. Comparative efficacy of warfarin and new oral anticoagulants in preparing patients with persistent, non-valvular atrial fibrillation for restoration of sinus rhythm. Russian Heart Journal. 2016;15 (6):435–440

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