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Rivaroxaban vs. Warfarin for Anticoagulation in Patients with Atrial Fibrillation Undergoing Ablation and Cardioversion

 


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Am Fam Physician. 2016 Oct 1;94(7):online.

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RIVAROXABAN VS. WARFARIN FOR ANTICOAGULATION IN PATIENTS WITH ATRIAL FIBRILLATION UNDERGOING ABLATION OR CARDIOVERSION

BenefitsHarms

433 patients treated with rivaroxaban to prevent one stroke

Major and minor bleeding complications were similar

629 patients treated with rivaroxaban to prevent one thromboembolic event

RIVAROXABAN VS. WARFARIN FOR ANTICOAGULATION IN PATIENTS WITH ATRIAL FIBRILLATION UNDERGOING ABLATION OR CARDIOVERSION

BenefitsHarms

433 patients treated with rivaroxaban to prevent one stroke

Major and minor bleeding complications were similar

629 patients treated with rivaroxaban to prevent one thromboembolic event

Details for This Review

Study Population: Adults with atrial fibrillation undergoing a catheter ablation or cardioversion who received anticoagulation with rivaroxaban (Xarelto) or vitamin K antagonists (such as warfarin [Coumadin])

Efficacy End Points: Prevention of thromboembolism (stroke, transient ischemic attack, systemic embolism, or pulmonary embolism)

Harm End Points: Major and minor bleeding complications

Narrative: Atrial fibrillation is a common diagnosis (2.7 to 6.1 million adults in the United States1), which is typically treated with anticoagulation to prevent thromboembolism. In particular, patients undergoing catheter ablation or cardioversion are at an increased risk of complications (thromboembolism and bleeding) caused by the activation of the clotting cascade in addition to the invasive nature of the techniques used.2 The development of new anticoagulants over the past couple of years has raised questions about the optimal choice for treatment. Evaluating these new anticoagulants is complicated because the incidence of thromboembolism and bleeding is thought to be near or below 1%, requiring a large collection of data to effe

REFERENCES

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1. January CT, Wann LS, Alpert JS, et al. 2014 AHA/ACC/HRS guideline 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 [published correction appears in J Am Coll Cardiol. 2014; 64(21):2305–2307]. J Am Coll Cardiol. 2014;64(21):e1–e70....

2. Oral H, Chugh A, Ozaydin M, et al. Risk of thromboembolic events after percutaneous left atrial radiofrequency ablation of atrial fibrillation. Circulation. 2006;114(8):759–765.

3. Nairooz R, Sardar P, Pino M, et al. Meta-analysis of risk of stroke and thrombo-embolism with rivaroxaban versus vitamin K antagonists in ablation and cardioversion of atrial fibrillation. Int J Cardiol. 2015;187:345–353.

4. Laliberté F, Cloutier M, Crivera C, et al. Effect of rivaroxaban versus warfarin on health care costs among non-valvular atrial fibrillation patients: observations from rivaroxaban users and matched warfarin users [published correction appears in Adv Ther. 2015;32(4):387]. Adv Ther. 2015;32(3):216–227.



 

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