Scripties UMCG - Rijksuniversiteit Groningen
English | Nederlands

A comparison of safety and effectiveness between treatment withvitamin K antagonists and NOACs in patients with symptomatic atrial fibrillation and a subgroup analysis after cardioversion. A real world study

(2018) Woelders, E.C.I.

Introduction: Atrium Fibrillation (AF) can lead to thromboembolic events. Vitamin K antagonists (VKAs) used to be the only oral anticoagulants available for the prevention of thrombi. Relatively new anticoagulants are the Non-vitamin K oral anticoagulants (NOACs). Our study objective is to compare all NOACs to both Acenocoumarol and Phenprocoumon in real world patients with symptomatic AF and after Cardioversion.
Methods: Retrospectively data was retrieved from electronic patients charts concerning symptomatic AF patients that presented at the ED of VieCuri MC and Maastricht UMC receiving either a VKA or one of the NOACs. Primary study outcomes were thromboembolic events and Haemorrhage.
Results: 308 patients were included. 146 patients in the VKA group and 162 in the NOAC group. The two groups showed several significant differences at baseline. Primary outcomes showed a slightly higher, although not significant event rate in the VKA group. Secondary study outcomes also show no significant differences except for recurrence of AF. Cox regression analysis showed a non-significant beneficial effect of NOACs on the combined outcome parameters.
Discussion/conclusion: NOACs showed to be at least as effective and safe as VKAs in symptomatic AF patients, also when they undergo cardioversion which implies that NOACs can be safely prescribed to prevent thrombi in this study population. The differences in baseline characteristics might bias the study outcomes. Secondary outcome analysis was limited due to low complication numbers. Future studies should include more patients in the database and using propensity score matching to correct for confounding factors.

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