Use of Novel Oral Anticoagulants Post-cardioversion in Atrial Fibrillation: A Safety Review

Atrial fibrillation is considered the most common sustained arrhythmia worldwide, especially in geriatric population and is associated with significant morbidity and mortality. Arterial embolization is the most serious complication of atrial fibrillation. Vitamin K antagonists were the only form of oral anticoagulant medication approved for long-term use since 1940s, till the advent of three novel oral anticoagulants- dabigatran, rivaroxaban and apixaban. The new anticoagulants are more convenient to administer than warfarin. Pivotal trials of these drugs showed that they are not only as effective as warfarin, but also cause less intracranial bleeding. There is data emerging regarding the safety of these agents in the context of cardioversion. The purpose of this review is to examine the current published safety data for the use of novel oral anticoagulants around the time of cardioversion.