Direct oral anticoagulants in patients undergoing cardioversion: insight from randomized clinical trials


  • Stefania Angela Di Fusco | San Filippo Neri Hospital, Italy.
  • Furio Colivicchi San Filippo Neri Hospital, Italy.
  • Nadia Aspromonte San Filippo Neri Hospital, Italy.
  • Marco Tubaro San Filippo Neri Hospital, Italy.
  • Alessandro Aiello San Filippo Neri Hospital, Italy.
  • Massimo Santini San Filippo Neri Hospital, Italy.


Anticoagulation, reducing the risk of thromboembolic events in patients undergoing cardioversion, is a cornerstone of peri-cardioversion management in patients with atrial fibrillation. We aimed to analyse published data on the efficacy and safety of direct oral anticoagulants (DOACs) in patients undergoing cardioversion. We performed a systematic review of randomized prospective clinical trials (RCTs) comparing DOACs with warfarin and reporting data on post-cardioversion outcomes of interest. Outcomes of interest were stroke, systemic thromboembolic events and major bleeding. We reviewed a total of six RCTs including 3900 cardioversions performed using a DOAC for thromboembolic prophylaxis. These studies reported a low incidence overall of adverse outcomes associated with the use of DOACs (around 1% in all studies, except the ROCKET post-hoc study which included ablation procedures). The incidence rate of adverse events during DOAC treatment was found to be very similar to that observed with warfarin anticoagulation. In RCTs DOAC treatment in patients undergoing cardioversion appears to be effective and safe. However, because evidence in this clinical setting is still weak, observational reports could be useful in providing further data about peri-procedural outcomes.



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Cardiology - Reviews
Oral anticoagulants, atrial fibrillation, cardioversion, randomized clinical trials.
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How to Cite
Di Fusco, Stefania Angela, Furio Colivicchi, Nadia Aspromonte, Marco Tubaro, Alessandro Aiello, and Massimo Santini. 2017. “Direct Oral Anticoagulants in Patients Undergoing Cardioversion: Insight from Randomized Clinical Trials”. Monaldi Archives for Chest Disease 87 (1).

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