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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EThis article presents results from the Explore the Efficacy and Safety of Once-Daily Oral Rivaroxaban for the Prevention of Cardiovascular Events in Subjects With Nonvalvular Atrial Fibrillation Scheduled for Cardioversion trial [X-VeRT; Cappato R et al. \u003Cem\u003EEur Heart J\u003C\/em\u003E. 2014]. The data showed that oral rivaroxaban was as effective and safe as a vitamin K antagonist when administered for only about a week prior to elective cardioversion for atrial fibrillation.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EInterventional Techniques \u0026amp; Devices\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EArrhythmias\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EInterventional Techniques \u0026amp; Devices\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EArrhythmias\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003ERiccardo Cappato, MD, Policlinico San Donato, San Donato Milanese, Italy, presented results from the Explore the Efficacy and Safety of Once-Daily Oral Rivaroxaban for the Prevention of Cardiovascular Events in Subjects With Nonvalvular Atrial Fibrillation Scheduled for Cardioversion trial [X-VeRT; Cappato R et al. \u003Cem\u003EEur Heart J\u003C\/em\u003E. 2014]. The data showed that oral rivaroxaban was as effective and safe as a vitamin K antagonist (VKA) when administered for only about a week prior to elective cardioversion for atrial fibrillation (AF).\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EAccording to Prof Cappato, although cardioversion is commonly performed worldwide to restore normal rhythm in patients with AF [Hern\u00e1ndez-Madrid A et al. \u003Cem\u003EEuropace\u003C\/em\u003E 2013], without appropriate anticoagulation therapy, the periprocedural risk of thromboembolism for this procedure is 5% to 7% [Stellbrink C et al. \u003Cem\u003ECirculation\u003C\/em\u003E 2004], compared with 1% for patients who receive a VKA [Gallagher Mm et al. \u003Cem\u003EJ Am Coll Cardiol\u003C\/em\u003E. 2002], the current standard of care pre- and post-cardioversion [Camm AJ et al. \u003Cem\u003EEur Heart J\u003C\/em\u003E. 2013].\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EX-VeRT is the first prospective randomized study designed to compare the efficacy and safety of a novel oral anticoagulant (NOAC) with dose-adjusted VKAs in patients with AF undergoing elective cardioversion. This open-label, parallel-group, active-controlled phase 3b trial enrolled 1504 subjects with hemodynamically stable nonvalvular AF who were scheduled for cardioversion from 141 centers throughout 16 countries.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EPatients were randomized 2:1 to rivaroxaban 20 mg once daily (15 mg if creatinine clearance was 30 to 49 mL\/min) or international normalized ratio (INR)-adjusted VKA therapy, including warfarin. Local study investigators decided whether patients underwent an early (target period of 1 to 5 d post randomization) or delayed (3 to 8 weeks) cardioversion strategy.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EThe primary efficacy outcome was the composite of stroke and transient ischemic attack (TIA), non\u2014central nervous system (CNS) systemic embolism, myocardial infarction, and cardiovascular death. The primary safety outcome was major bleeding, according to International Society on Thrombosis and Haemostasis recommendations.\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EThe primary efficacy outcome occurred in 0.51% of the rivaroxaban group and 1.02% of the VKA group (RR, 0.50; 95% CI, 0.15 to 1.73). In patients who underwent early cardioversion, the primary composite outcome occurred in 0.71% of the rivaroxaban group vs 1.08% of the VKA group, and in 0.24% vs 0.93% of those who underwent delayed cardioversion.\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003EThe incidence of major bleeding was similar in patients treated with rivaroxaban and VKAs (0.6% vs 0.8%; RR, 0.76; 95% CI, 0.21 to 2.67).\u003C\/p\u003E\u003Cp id=\u0022p-9\u0022\u003EIn patients selected for early cardioversion, time to cardioversion was similar in both treatment groups (\u003Cem\u003EP\u003C\/em\u003E = .628), but in those selected for delayed cardioversion, it was significantly shorter in patients who received r ivaroxaban compared with VKAs (\u003Cem\u003EP\u003C\/em\u003E \u0026lt; .001; \u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E).\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/27\/27.1\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Effects of Rivaroxaban and Vitamin K Antagonists on Time to Cardioversion\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1080659356\u0022 data-figure-caption=\u0022Effects of Rivaroxaban and Vitamin K Antagonists on Time to Cardioversion\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/27\/27.1\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/27\/27.1\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/27\/27.1\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/14986\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-10\u0022 class=\u0022first-child\u0022\u003EEffects of Rivaroxaban and Vitamin K Antagonists on Time to Cardioversion\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EVKA, vitamin K antagonist; INR, international normalized ratio. \u003Csup\u003Ea\u003C\/sup\u003E Reason for not performing cardioversion as first scheduled from 21\u201325 days primarily due to inadequate anticoagulation (indicated by drug compliance \u0026lt;80% for rivaroxaban or weekly INRs outside the range of 2.0\u20133.0 for 3 consecutive weeks before cardioversion for VKA).\u003C\/q\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-2\u0022\u003EReproduced with permission from R Cappato, MD.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-11\u0022\u003EProf Cappato emphasized that differences in the primary efficacy and safety outcomes between the groups were not significant because this study was not powered to determine statistical significance. He concluded, however, that the results thus far suggest reassuring efficacy and safety profiles for rivaroxaban, and imply that this NOAC may represent a promising alternative to VKAs, allowing prompt, elective cardioversion in patients with A F.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2014 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/14\/27\/27.1.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzoule\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzoule\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}