Atrial Fibrillation Treatment Expedited with Non-Vitamin K Antagonist Anticoagulants

A recent clinical trial found that edoxaban, a non-vitamin K antagonist oral anticoagulant (NOAC), shows equivalent efficacy to warfarin for cardioversion in patients with atrial fibrillation.

Atrial fibrillation is a common heart problem that can increase the risk of stroke and death. The irregular heart beat that leads to atrial fibrillation is caused by abnormal electrical impulses in the atria.

Electrical cardioversion, antiarrhythmic drugs, or a combination of both methods are utilized in an attempt to restore a normal heartbeat, according to a study published by The Lancet. Current recommendations call for at least 3 weeks of anticoagulation treatment before cardioversion to prevent blood clotting and increased stroke risk.

The current anticoagulation treatment is typically done with vitamin K antagonists, such as warfarin. However, the efficacy of the drug varies from patient to patient, and can delay the start of cardioversion if the patient does not respond well.

Treatment with warfarin is also known to increase the risk of hemorrhage, including intracranial bleeding.

In the trial, scientists compared a 60-mg daily dose of edoxaban against the current standard treatment in 2199 patients with non-valvular atrial fibrillation. There were 1067 patients who received edoxaban, and 1082 who received the standard treatment of enoxaparin and warfarin.

Investigators found that edoxaban would be a safe alternative to vitamin K antagonists, and could expedite the process from initial treatment to elective cardioversion when applying a transesophageal echocardiography-guided approach, according to the study. Only 5 patients taking edoxaban experienced a stroke, systemic embolism, myocardial infarction, or another event, compared with 11 patients taking enoxaparin and warfarin.

Both the NOAC and the vitamin K antagonist are considered safe for use. However, edoxaban can expedite the time it takes to move from initial treatment to cardioversion

“The purpose of this trial was to optimize care for patients undergoing restorative treatment for atrial fibrillation. Both the optimized use of warfarin, and in this case edoxaban, displayed very low numbers of events and can be considered as safe,” said researcher Gregory Lip, PhD. “What we present here is the option for using NOACs such as edoxaban as a more efficient, user-friendly choice before cardioversion. But before that comes into place, it needs the support of revised guidelines and supporting education for healthcare practitioners and patients alike.”