Andò Giuseppe, Trio Olimpia, Carerj Scipione
Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
Expert Rev Cardiovasc Ther. 2015 May;13(5):577-83. doi: 10.1586/14779072.2015.1024107. Epub 2015 Mar 22.
Scarce data are available about efficacy and safety of new oral anticoagulants (NOACs) for cardioversion (CV) of atrial fibrillation (AF). We performed a meta-analysis of data from randomized studies reporting outcomes of patients receiving NOACs, as compared to vitamin K antagonists (VKAs), and undergoing CV of AF.
Data from four studies were selected, including 4268 CVs. The primary endpoints were the incidence of stroke or systemic embolism and the incidence of major bleeding within 30 days.
There was not any significant difference in the incidence of stroke or systemic embolism between NOACs and VKAs (RR 0.73, p = 0.47) nor in the incidence of major bleeding (RR 1.39, p = 0.13).
We found no evidence of differential outcomes after CV of AF according to treatment with NOACs or VKAs. This finding warrants confirmation in larger clinical series and in the setting of properly powered randomized trials of newly diagnosed AF.
关于新型口服抗凝药（NOACs）用于心房颤动（AF）复律（CV）的疗效和安全性的数据稀缺。我们对随机研究的数据进行了荟萃分析，这些研究报告了接受NOACs治疗的患者与接受维生素K拮抗剂（VKAs）治疗的患者进行AF复律后的结果。
选取了四项研究的数据，包括4268例复律。主要终点是30天内中风或全身性栓塞的发生率以及大出血的发生率。
NOACs组和VKAs组在中风或全身性栓塞的发生率（RR 0.73，p = 0.47）以及大出血的发生率（RR 1.39，p = 0.13）方面均无显著差异。
我们没有发现证据表明AF复律后使用NOACs或VKAs治疗会产生不同的结果。这一发现需要在更大的临床系列以及新诊断AF的适当规模随机试验中得到证实。
