Comparative efficacy of warfarin and new oral anticoagulants in preparing patients with persistent, non-valvular atrial fibrillation for restoration of sinus rhythm

Background . Clinical significance of (AF) is related primarily with its thromboembolic complications. The probability of thromboembolic complications increases during cardioversion. Aim . To compare the incidence of detecting contraindications for cardioversion (left atrial appendage thrombosis or high-degree spontaneous echocontrast) using transesophageal EchoCG in patients with persistent, non-valvular AF receiving pre-cardioversion therapy with warfarin and new oral anticoagulants (NOACs) (dabigatran and rivaroxaban). Materials and methods. Transesophageal EcoCG was performed for 208 patients with persistent, non-valvular AF; during preparation for cardioversion, 140 of them received warfarin and 68 received NOACs). Results. The anticoagulant preparation was con-sidered inadequate for patients receiving warfarin and only for 38.6% of patients receiving NOACs. When the anticoagulant preparation was adequate, contraindications for cardioversion were identified in 16.3% of patients receiving warfarin and 9.5% of patients receiving NOACs. Among patients receiving inadequate anticoagulant therapy, contraindications for cardioversion were identified in 37.3 % of cases. Conclusion. Using NOACs 7.91 times decreased the probability of inadequate anticoagulant therapy. With the adequate NOAC therapy, the probability of remaining contraindications for cardioversion was 2.9 times lower than with the adequate warfarin therapy.