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Atrial fibrillation patients with CHA2DS2-VASc > 1 benefit from oral anticoagulation prior to cardioversion

Själander, Sara; Svensson, Peter J. LU and Friberg, Leif (2016) In International Journal of Cardiology 215. p.360-363
Abstract

Background Electrical cardioversion of atrial fibrillation is associated with an increased risk of embolic stroke, but is generally considered safe if performed within 48 h after onset. Our objective was to investigate if thromboembolism and bleeding in association with cardioversion of atrial fibrillation differed between patients with and without oral anticoagulation. Methods Retrospective study of patients with atrial fibrillation undergoing electrical cardioversion from national Swedish health registries from January 1st 2006 until December 1st 2010. Main outcome measures were thromboembolism and bleeding. Results In total 22,874 atrial fibrillation patients underwent electrical cardioversion, 10,722 with and 12,152 without oral... (More)

Background Electrical cardioversion of atrial fibrillation is associated with an increased risk of embolic stroke, but is generally considered safe if performed within 48 h after onset. Our objective was to investigate if thromboembolism and bleeding in association with cardioversion of atrial fibrillation differed between patients with and without oral anticoagulation. Methods Retrospective study of patients with atrial fibrillation undergoing electrical cardioversion from national Swedish health registries from January 1st 2006 until December 1st 2010. Main outcome measures were thromboembolism and bleeding. Results In total 22,874 atrial fibrillation patients underwent electrical cardioversion, 10,722 with and 12,152 without oral anticoagulation pre-treatment. Patients with low stroke risk (CHA2DS2-VASc 0-1) did not suffer from any thromboembolic complications within 30 days after cardioversion. After adjustment for factors included in CHA2DS2-VASc and after propensity score matching, patients without oral anticoagulation had higher risk for thromboembolic complications, odds ratio 2.54 (95% confidence interval 1.70-3.79) and odds ratio 2.51 (95% confidence interval 1.69-3.75). There were no significant differences regarding bleeding complications between patients with or without anticoagulation after adjustment for factors included in HAS-BLED, odds ratio 1.08 (95% confidence interval 0.51-2.25), nor after propensity score matching, odds ratio 1.00 (95% confidence interval 0.48-2.10). Conclusion The results suggest that electrical cardioversion without prior anticoagulation may not be safe for patients with risk factors for thromboembolism (CHA2DS2-VASc score > 1 point).

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Atrial fibrillation, Electrical cardioversion, Oral anticoagulation, Thromboembolism
in
International Journal of Cardiology
volume
215
pages
4 pages
publisher
Elsevier
external identifiers
  • Scopus:84964252990
ISSN
0167-5273
DOI
10.1016/j.ijcard.2016.04.031
language
English
LU publication?
yes
id
3aabedf9-a573-45ce-ab4a-dcc4e7a6b467
date added to LUP
2016-05-10 07:31:29
date last changed
2016-11-14 09:42:51
@misc{3aabedf9-a573-45ce-ab4a-dcc4e7a6b467,
  abstract     = {<p>Background Electrical cardioversion of atrial fibrillation is associated with an increased risk of embolic stroke, but is generally considered safe if performed within 48 h after onset. Our objective was to investigate if thromboembolism and bleeding in association with cardioversion of atrial fibrillation differed between patients with and without oral anticoagulation. Methods Retrospective study of patients with atrial fibrillation undergoing electrical cardioversion from national Swedish health registries from January 1st 2006 until December 1st 2010. Main outcome measures were thromboembolism and bleeding. Results In total 22,874 atrial fibrillation patients underwent electrical cardioversion, 10,722 with and 12,152 without oral anticoagulation pre-treatment. Patients with low stroke risk (CHA<sub>2</sub>DS<sub>2</sub>-VASc 0-1) did not suffer from any thromboembolic complications within 30 days after cardioversion. After adjustment for factors included in CHA<sub>2</sub>DS<sub>2</sub>-VASc and after propensity score matching, patients without oral anticoagulation had higher risk for thromboembolic complications, odds ratio 2.54 (95% confidence interval 1.70-3.79) and odds ratio 2.51 (95% confidence interval 1.69-3.75). There were no significant differences regarding bleeding complications between patients with or without anticoagulation after adjustment for factors included in HAS-BLED, odds ratio 1.08 (95% confidence interval 0.51-2.25), nor after propensity score matching, odds ratio 1.00 (95% confidence interval 0.48-2.10). Conclusion The results suggest that electrical cardioversion without prior anticoagulation may not be safe for patients with risk factors for thromboembolism (CHA<sub>2</sub>DS<sub>2</sub>-VASc score &gt; 1 point).</p>},
  author       = {Själander, Sara and Svensson, Peter J. and Friberg, Leif},
  issn         = {0167-5273},
  keyword      = {Atrial fibrillation,Electrical cardioversion,Oral anticoagulation,Thromboembolism},
  language     = {eng},
  month        = {07},
  pages        = {360--363},
  publisher    = {ARRAY(0xb6b7f30)},
  series       = {International Journal of Cardiology},
  title        = {Atrial fibrillation patients with CHA<sub>2</sub>DS<sub>2</sub>-VASc > 1 benefit from oral anticoagulation prior to cardioversion},
  url          = {http://dx.doi.org/10.1016/j.ijcard.2016.04.031},
  volume       = {215},
  year         = {2016},
}