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Europace. 2015 Jan;17(1):18-23. doi: 10.1093/europace/euu189. Epub 2014 Sep 17.

Thromboembolic risk in 16 274 atrial fibrillation patients undergoing direct current cardioversion with and without oral anticoagulant therapy.

Author information

1
Department of Cardiology, Copenhagen University Hospital Gentofte, Niels Andersens Vej 65, 2900 Hellerup, Denmark mortenlh@yahoo.com.
2
Danish Institute for Medical Simulation, Copenhagen University Hospital, Herlev 2730, Denmark.
3
Department of Cardiology, Copenhagen University Hospital Gentofte, Niels Andersens Vej 65, 2900 Hellerup, Denmark.
4
Department of Cardiology, The Heart Centre, Rigshospitalet-Copenhagen University Hospital, 2100 Copenhagen, Denmark.
5
Department of Medicine, Herning Hospital, Herning 7400, Denmark.
6
Department of Health Science and Technology, Aalborg University, 9220 Aalborg, Denmark.

Abstract

AIMS:

To study the risk of thromboembolism in a nationwide cohort of atrial fibrillation patients undergoing direct current (DC) cardioversion with or without oral anticoagulant coverage.

METHODS AND RESULTS:

A retrospective study of 16 274 patients in Denmark discharged from hospital after a first-time DC cardioversion for atrial fibrillation between 2000 and 2008. Use of oral anticoagulant therapy within 90 days prior and 360 days after DC cardioversion was obtained from the Danish Register of Medicinal Product Statistics. The risk of thromboembolism was estimated by calculating incidence rates and by multivariable adjusted Cox proportional-hazard models. During the initial 30 days following discharge, the thromboembolic incidence rate was 10.33 per 100 patient-years for the no prior oral anticoagulant therapy group [n = 5084 (31.2%)], as compared with 4.00 per 100 patient-years for the prior oral anticoagulant therapy group [n = 11 190 (68.8%)], [hazard ratio associated with no prior oral anticoagulant therapy was 2.25; 95% confidence interval (CI), 1.43-3.53]. Thromboembolic risk stratification by the CHADS2 and CHA2DS2-VASc scores did not change the results. Hazard ratio with no oral anticoagulant therapy was 2.21; 95% CI, 0.79-6.77 and 2.40; 95% CI, 1.46-3.95 with CHA2DS2-VASc score 0-1 and CHA2DS2-VASc score 2 or more, respectively.

CONCLUSION:

Direct current cardioversion for atrial fibrillation without oral anticoagulation is associated with a high risk of thromboembolism. Notably, the risk is high in the initial period after cardioversion, indicating a hazardous association between DC cardioversion without anticoagulation and thromboembolism.

KEYWORDS:

Atrial fibrillation; Direct current cardioversion; Oral anticoagulation; Thromboembolism

PMID:
25231909
DOI:
10.1093/europace/euu189
[Indexed for MEDLINE]

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