Experience with Apixaban Versus Acenocumarol in Usual Clinical Practice in Patients with Persistent Non-Valvular Atrial Fibrillation Treated with Electric Cardioversion Ambulatory

Abstract

Abstract Background The present work was carried out with the objective of evaluating the effects on inflammatory factors and on the consumption of resources in health care, in anti-coagulated patients with apixaban or acenocoumarol, treated with electric cardioversion ambulatory (ECV). Methods 236 patients with non-valvular atrial fibrillation (NVAF), who underwent ambulatory CVE between April 2017 and October 2020, were prospectively analyzed. The levels of IL-6, TNF-α, IL-10 and TGF-β were measured before cardioversion and one month after cardioversion. Results The mean age of the study population was 71 years, 52% with a history of NVAF prior to the index event. The procedure was successful in 90% of the patients (n = 210). The average number of shocks per patient was 1.39 joules. A transesophageal echocardiogram was performed in 236 patients (100%), which revealed thrombus in the left atrium in 2 of them. Among the anticoagulated patients with acenocoumarol (N 50), 7 patients (14%) with sub-optimal INR were registered, who were reprogrammed for ECV. The delay time until performing the CVE was 30 ± 7, with an impact on the waiting list of 2 months. A statistically significant decrease in the apixaban treatment arm was recorded in the assessment of pro-inflammatory cytokine levels. Conclusions Ambulatory ECV is a safe and effective method for the treatment of NVAF in patients anticoagulated with apixaban or acenocoumarol. An advantage of the use of DOAC (Direct Oral Anticoagulant) in the context of peri-cardioversion is to avoid inadequate control of the INR, a frequent reason for suspending scheduled electrical cardioversions, increased of waiting lists and healthcare costs. Apixaban showed a decrease in levels of pro-inflammatory factors (IL6 - TNF-α). This effect could be related with prediction of mortality risk as other studies have shown.