TY - JOUR T1 - Patterns of oral anticoagulation use with cardioversion in clinical practice JF - Heart JO - Heart DO - 10.1136/heartjnl-2019-316315 SP - heartjnl-2019-316315 AU - Kyle Geurink AU - DaJuanicia Holmes AU - Michael D Ezekowitz AU - Karen Pieper AU - Gregg Fonarow AU - Peter R Kowey AU - James A Reiffel AU - Daniel E Singer AU - James Freeman AU - Bernard J Gersh AU - Kenneth W Mahaffey AU - Elaine M Hylek AU - Gerald Naccarelli AU - Jonathan P Piccini AU - Eric D Peterson AU - Sean D Pokorney Y1 - 2020/06/26 UR - http://heart.bmj.com/content/early/2020/06/26/heartjnl-2019-316315.abstract N2 - Background Cardioversion is common among patients with atrial fibrillation (AF). We hypothesised that novel oral anticoagulants (NOAC) used in clinical practice resulted in similar rates of stroke compared with vitamin K antagonists (VKA) for cardioversion.Methods Using the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation II, patients with AF who had a cardioversion, follow-up data and an AF diagnosis within 6 months of enrolment were identified retrospectively. Clinical outcomes were compared for patients receiving a NOAC or VKA for 1 year following cardioversion.Results Among 13 004 patients with AF, 2260 (17%) underwent cardioversion. 1613 met the inclusion criteria for this analysis. At the time of cardioversion, 283 (17.5%) were receiving a VKA and 1330 (82.5%) a NOAC. A transoesophageal echocardiogram (TOE) was performed in 403 (25%) cardioversions. The incidence of stroke/transient ischaemic attack (TIA) at 30 days was the same for patients having (3.04 per 100 patient-years) or not having (3.04 per 100 patient-years) a TOE (p=0.99). There were no differences in the incidence of death (HR 1.19, 95% CI 0.62 to 2.28, p=0.61), cardiovascular hospitalisation (HR 1.02, 95% CI 0.76 to 1.35, p=0.91), stroke/TIA (HR 1.18, 95% CI 0.30 to 4.74, p=0.81) or bleeding-related hospitalisation (HR 1.29, 95% CI 0.66 to 2.52, p=0.45) at 1 year for patients treated with either a NOAC or VKA.Conclusions Cardioversion was a low-risk procedure for patients treated with NOAC, and there were statistically similar rates of stroke/TIA 30 days after cardioversion as for patients treated with VKA. There were no statically significant differences in death, stroke/TIA or major bleeding at 1 year among patients treated with NOAC compared with VKA after cardioversion. ER -