The oral anticoagulant rivaroxaban appears to safely and effectively prevent the risk of stroke associated with cardioversion in patients with atrial fibrillation, according to a randomized trial of 1504 patients (Cappato R et al. Eur Heart J. doi:10.1093/eurheartj/ehu367 [published online September 2, 2014]). Rivaroxaban’s action in 2 to 4 hours also allowed for more rapid cardioversion than vitamin K antagonists.
Patients scheduled for elective cardioversion were assigned to receive rivaroxaban or dose-adjusted vitamin K antagonists. Researchers chose either an early (target period of 1-5 days after randomization) or delayed (3-8 weeks) cardioversion strategy. Patients taking rivaroxaban in the early and delayed cardioversion groups had low thromboembolic and bleeding risks that were similar to those seen with treatment with vitamin K antagonists.
Slomski A. Rivaroxaban Viable as Alternative Anticoagulant for Cardioversion. JAMA. 2014;312(16):1624. doi:10.1001/jama.2014.13119