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Clinical Articles, News & Views

Apixaban can continue during cardioversion

Patients with non valvular atrial fibrillation (NVAF) should remain on apixaban while undergoing cardioversion, according to a recommendation from the European Medicines Agency’s Committee for Medicinal Products for Human Use (CHMP).1

The CHMP’s positive opinion was based on a post-hoc analysis of the outcomes of the ARISTOTLE (Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation) study. 540 patients underwent 743 cardioversions for NVAF. The outcomes of patients treated with apixaban (n=265) compared to those treated with warfarin (n=275) were assessed in the 30 days following cardioversion attempts.2 Adverse clinical events occurring after cardioversion were found to be comparable between the warfarin and apixaban groups with no reported stroke or systemic emboli in either group and low observed rates of myocardial infarction, major bleeding or death.2

“The summary of product characteristics (SmPC) update is significant because it means that NVAF patients will no longer have to change anticoagulation therapy prior to cardioversion, and apixaban therapy can now be continued without interruption,” said Professor John Camm (St George’s Hospital, London).

“The fact that this ARISTOTLE analysis showed that there were no strokes or systemic emboli in the apixaban group, and that adverse events were low and balanced between the treatment arms, provides reassurance that patients already taking apixaban who need cardioversion can continue to take this oral anticoagulant while they are being cardioverted,” Professor Camm added.


1. Opinion of the committee for medicinal products for human use on a type II variation to the terms of the marketing authorisation for Eliquis (apixaban) – EMA/CHMP/233170/2014. 25 April 2014

2. Flaker G et al. Efficacy and safety of apixaban in patients after cardioversion for atrial fibrillation: insights from the ARISTOTLE trial. J Am Col Card 2014;63:1082–7.

Published on: May 28, 2014

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  • ArrhythmiaAlliance
  • Stars
  • Anticoagulation Europe
  • Atrial Fibrillation Association

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