Risk of stroke with reduced dose direct oral anticoagulants vs standard dose anticoagulation after cardioversion of atrial fibrillation: A systematic review and meta-analysis
Bibliographic record
Abstract
<h3>Background</h3> 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. <h3>Objective</h3> 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. <h3>Methods</h3> 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. <h3>Results</h3> 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; <i>P</i> = .19; I<sup>2</sup> = 0%); however, the difference was not statistically significant. <h3>Conclusion</h3> 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.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.014 | 0.005 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".