Evidence map›Paper›PMID 39803618›Full record

ArticleHeart rhythm O22024

Risk of stroke with reduced dose direct oral anticoagulants vs standard dose anticoagulation after cardioversion of atrial fibrillation: A systematic review and meta-analysis.

Travis Quevillon, Erik Slade, Faith Michael, Alexander P Benz, William F McIntyre, Ratika Parkash, Jeff S Healey, Dennis T Ko, Mohammed Shurrab

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Heart rhythm O2, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Travis QuevillonCardiology Department, Health Sciences North Research Institute, Northern Ontario School of Medicine University, Sudbury, Ontario, Canada.
Erik SladeCardiology Department, Health Sciences North Research Institute, Northern Ontario School of Medicine University, Sudbury, Ontario, Canada.
Faith MichaelCardiology Department, Health Sciences North Research Institute, Northern Ontario School of Medicine University, Sudbury, Ontario, Canada.
Alexander P BenzPopulation Health Research Institute, McMaster University, Hamilton, Ontario, Canada.
William F McIntyrePopulation Health Research Institute, McMaster University, Hamilton, Ontario, Canada.
Ratika ParkashDivision of Cardiology, Queen Elizabeth II Health Sciences Center, Dalhousie University, Halifax, Nova Scotia, Canada.
Jeff S HealeyPopulation Health Research Institute, McMaster University, Hamilton, Ontario, Canada.
Dennis T KoDivision of Cardiology, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
Mohammed ShurrabCardiology Department, Health Sciences North Research Institute, Northern Ontario School of Medicine University, Sudbury, Ontario, Canada.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Background: There is consensus on the safety of standard dose direct oral anticoagulants (DOACs) for stroke prevention in patients undergoing cardioversion of atrial fibrillation (AF), but outcomes of reduced dose DOACs in this setting remain unclear. Objective: This systematic review and meta-analysis aimed to compare the rate of cardioversion-associated thromboembolic events between patients taking reduced dose DOACs and those receiving standard dose anticoagulation. Methods: A systematic search was conducted for studies published between January 1, 2009, and February 16, 2024 in PubMed, Embase, and Cochrane Central Register of Controlled Trials. The included studies compared the rate of thromboembolic events in patients with AF undergoing cardioversion on reduced dose DOACs with the rate in those on standard dose anticoagulation. Odds ratios were pooled with a random effects model. Results: We identified 2 randomized controlled trials and 8 cohort studies, which included 5212 patients with AF who underwent cardioversion on anticoagulation (1010 patients on reduced dose DOACs and 4202 patients on standard dose anticoagulation). Follow-up ranged from 3 hours to 90 days after cardioversion. There was a numerically higher rate of thromboembolic events in patients undergoing cardioversion on reduced dose DOACs than in those on standard dose anticoagulation (0.69% vs 0.29%; odds ratio 1.98; 95% confidence interval 0.72-5.45; Conclusion: Our systematic review and meta-analysis suggests that there is a numerically higher risk of thromboembolic events in patients with AF undergoing cardioversion on reduced dose DOACs than in those on standard dose anticoagulation. However, the difference was not statistically significant. These findings raise concern about the safety of reduced dose DOACs in patients undergoing cardioversion.

Indexed as

Atrial fibrillationCardioversionReduced dose DOACsStandard dose anticoagulationThromboembolic events

Identifiers

PMID39803618
PMCPMC11721732

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LicenceCC BY-NC-ND
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.