***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Aims R and omized trials showed non-inferior or superior results of the non-vitamin-K-antagonist oral anticoagulants ( NOACs ) compared with warfarin . The aim of this study was to assess the effectiveness and safety of dabigatran ( direct thrombin inhibitor ) vs. acenocoumarol ( vitamin K antagonist ) in patients with atrial fibrillation ( AF ) in daily clinical practice . Methods and results In this observational study , we evaluated all consecutive patients who started anticoagulation because of AF in our outpatient clinic from 2010 to 2013 . Data were collected from electronic patient charts . Primary outcomes were stroke or systemic embolism and major bleeding . Propensity score matching was applied to address the non-r and omized design . In total , 920 consecutive AF patients were enrolled ( 442 dabigatran , 478 acenocoumarol ) , of which 2 × 383 were available for analysis after propensity score matching . Mean follow-up duration was 1.5 ± 0.56 year . The mean calculated stroke risk according to the CHA2DS2-VASc score was 3.5%/year in dabigatran vs. 3.7%/year acenocoumarol-treated patients . The actual incidence rate of stroke or systemic embolism was 0.8%/year [ 95 % confidence interval ( CI ) : 0.2–2.1 ] vs. 1.0%/year ( 95 % CI : 0.4–2.1 ) , respectively . Multivariable analysis confirmed this lower but non-significant risk in dabigatran vs. acenocoumarol after adjustment for the CHA2DS2-VASc score [ hazard ratio (HR)dabigatran = 0.72 , 95 % CI : 0.20–2.63 , P = 0.61 ] . According to the HAS-BLED score , the mean calculated bleeding risk was 1.7%/year in both groups . Actual incidence rate of major bleeding was 2.1%/year ( 95 % CI : 1.0–3.8 ) in the dabigatran vs. 4.3%/year ( 95 % CI : 2.9–6.2 ) in acenocoumarol . This over 50 % reduction remained significant after adjustment for the HAS-BLED score ( HRdabigatran = 0.45 , 95 % CI : 0.22–0.93 , P = 0.031 ) . Conclusion In ‘ real-world ’ patients with AF , dabigatran appears to be as effective , but significantly safer than acenocoumarol Background — Dabigatran and warfarin have been compared for the treatment of acute venous thromboembolism ( VTE ) in a previous trial . We undertook this study to extend those findings . Methods and Results — In a r and omized , double-blind , double-dummy trial of 2589 patients with acute VTE treated with low-molecular-weight or unfractionated heparin for 5 to 11 days , we compared dabigatran 150 mg twice daily with warfarin . The primary outcome , recurrent symptomatic , objective ly confirmed VTE and related deaths during 6 months of treatment occurred in 30 of the 1279 dabigatran patients ( 2.3 % ) compared with 28 of the 1289 warfarin patients ( 2.2 % ; hazard ratio , 1.08 ; 95 % confidence interval [ CI ] , 0.64–1.80 ; absolute risk difference , 0.2 % ; 95 % CI , −1.0 to 1.3 ; P<0.001 for the prespecified noninferiority margin for both criteria ) . The safety end point , major bleeding , occurred in 15 patients receiving dabigatran ( 1.2 % ) and in 22 receiving warfarin ( 1.7 % ; hazard ratio , 0.69 ; 95 % CI , 0.36–1.32 ) . Any bleeding occurred in 200 dabigatran ( 15.6 % ) and 285 warfarin ( 22.1 % ; hazard ratio , 0.67 ; 95 % CI , 0.56–0.81 ) patients . Deaths , adverse events , and acute coronary syndromes were similar in both groups . Pooled analysis of this study RE-COVER II and the RE-COVER trial gave hazard ratios for recurrent VTE of 1.09 ( 95 % CI , 0.76–1.57 ) , for major bleeding of 0.73 ( 95 % CI , 0.48–1.11 ) , and for any bleeding of 0.70 ( 95 % CI , 0.61–0.79 ) . Conclusion — Dabigatran has similar effects on VTE recurrence and a lower risk of bleeding compared with warfarin for the treatment of acute VTE . Clinical Trial Registration — URL : www . clinical trials.gov . Unique identifiers : NCT00680186 and NCT00291330 Background — The R and omized Evaluation of Long-Term Anticoagulation Therapy ( RE-LY ) trial compared dabigatran 110 mg BID ( D110 ) and 150 mg BID ( D150 ) with warfarin for stroke prevention in 18 113 patients with nonvalvular atrial fibrillation . Methods and Results — Cardioversion on r and omized treatment was permitted . Precardioversion transesophageal echocardiography was encouraged , particularly in dabigatran-assigned patients . Data from before , during , and 30 days after cardioversion were analyzed . A total of 1983 cardioversions were performed in 1270 patients : 647 , 672 , and 664 in the D110 , D150 , and warfarin groups , respectively . For D110 , D150 , and warfarin , transesophageal echocardiography was performed before 25.5 % , 24.1 % , and 13.3 % of cardioversions , of which 1.8 % , 1.2 % , and 1.1 % were positive for left atrial thrombi . Continuous treatment with study drug for ≥3 weeks before cardioversion was lower in D110 ( 76.4 % ) and D150 ( 79.2 % ) compared with warfarin ( 85.5 % ; P<0.01 for both ) . Stroke and systemic embolism rates at 30 days were 0.8 % , 0.3 % , and 0.6 % ( D110 versus warfarin , P=0.71 ; D150 versus warfarin , P=0.40 ) and similar in patients with and without transesophageal echocardiography . Major bleeding rates were 1.7 % , 0.6 % , and 0.6 % ( D110 versus warfarin , P=0.06 ; D150 versus warfarin , P=0.99 ) . Conclusions — This study is the largest cardioversion experience to date and the first to evaluate a novel anticoagulant in this setting . The frequencies of stroke and major bleeding within 30 days of cardioversion on the 2 doses of dabigatran were low and comparable to those on warfarin with or without transesophageal echocardiography guidance . Dabigatran is a reasonable alternative to warfarin in patients requiring cardioversion . Clinical Trial Registration — URL : http://www . Clinical Trials.gov . Unique identifier : NCT00262600 Abstract Aims In patients with atrial fibrillation ( AF )  pharmacological or electrical cardioversion may be performed to restore sinus rhythm . The procedure is associated with an increased risk of thromboembolic events , which can be significantly reduced by adequate anticoagulation ( OAC ) . Our aim was to create a partly prospect i ve , partly retrospective cardioversion registry , particularly focusing on OAC strategies in different European countries , and on emerging choice of OAC over time . Methods From September 2014 to October 2015 , cardioversions due to AF performed in six European city hospitals in five European countries ( Hungary : Budapest-1 and -2 ; Italy : Bari and Pisa ; France : Amiens ; Spain : Madrid ; and Lithuania : Kaunas ) were recorded in the registry . Results A total of 1101 patients ( retrospective/ prospect i ve : 679/422 , male/female : 742/359 , mean age : 67.3 years ± 11.2 ) were registered . Most of the cardioversions were electrical ( 97 % ) . Oral anticoagulants were administered in 87 % of the patient , the usage of non-VKA oral anticoagulants ( NOACs ) vs Vitamin K antagonists ( VKA ) was 31.5 % vs 68.5 % , respectively . Seventy seven percent of the patients were given oral anticoagulants more than 3 weeks prior to the procedure , and 86 % more than 4 weeks after the procedure . When using VKA , international normalized ratio ( INR ) at cardioversion was above 2.0 in 76 % of the cases . A decline in VKA usage ( P = 0.033 ) in elective cardioversion over approximately 1 year was observed . During the observation period , there was an increase in  apixaban ( P < 0.001 ) , a slight increase in  rivaroxaban ( P = 0.028 ) and no changes in dabigatran ( P = 0.34 ) usage for elective cardioversion . There were differences in use of OAC between the countries : Spain used most VKA ( 89 % ) , while France used least VKA ( 39 % , P < 0.001 ) . Conclusion According to current AF guidelines , NOACs are adequate alternatives to VKA for thromboembolic prevention in AF patients undergoing elective cardioversion . Our results indicate that NOAC use is increasing and there is a significant decrease in VKA use Abstract Aim The primary objective was to compare apixaban to heparin/vitamin K antagonist ( VKA ) in patients with atrial fibrillation ( AF ) and ≤48 h anticoagulation prior to r and omization undergoing cardioversion . Methods One thous and five hundred patients were r and omized . The apixaban dose of 5 mg b.i.d . was reduced to 2.5 mg b.i.d . in patients with two of the following : age ≥ 80 years , weight ≤ 60 kg , or serum creatinine ≥ 133 µmol/L. To expedite cardioversion , at the discretion of the investigator , imaging and /or a loading dose of 10 mg ( down-titrated to 5 mg ) was allowed . The endpoints for efficacy were stroke , systemic embolism ( SE ) , and death . The endpoints for safety were major bleeding and clinical ly relevant non-major ( CRNM ) bleeding . Results There were 1038 active and 300 spontaneous cardioversions ; 162 patients were not cardioverted . Imaging was performed in 855 patients , and 342 received a loading dose of apixaban . Comparing apixaban to heparin/VKA in the full analysis set , there were 0/753 vs. 6/747 strokes [ relative risk ( RR ) 0 ; 95 % confidence interval ( 95 % CI ) 0–0.64 ; nominal P = 0.015 ] , no SE , and 2 vs. 1 deaths ( RR 1.98 ; 95 % CI 0.19–54.00 ; nominal P > 0.999 ) . In the safety population , there were 3/735 vs. 6/721 major ( RR 0.49 ; 95 % CI 0.10–2.07 ; nominal P = 0.338 ) and 11 vs. 13 CRNM bleeding events ( RR 0.83 ; 95 % CI 0.34–1.89 ; nominal P = 0.685 ) . On imaging , 60/61 with thrombi continued r and omized treatment ; all ( 61 ) were without outcome events . Conclusions Rates of strokes , systemic emboli , deaths , and bleeds were low for both apixaban and heparin/VKA treated AF patients undergoing cardioversion . Clinical Trials.gov number Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more BACKGROUND Edoxaban is a direct oral factor Xa inhibitor with proven antithrombotic effects . The long-term efficacy and safety of edoxaban as compared with warfarin in patients with atrial fibrillation is not known . METHODS We conducted a r and omized , double-blind , double-dummy trial comparing two once-daily regimens of edoxaban with warfarin in 21,105 patients with moderate-to-high-risk atrial fibrillation ( median follow-up , 2.8 years ) . The primary efficacy end point was stroke or systemic embolism . Each edoxaban regimen was tested for noninferiority to warfarin during the treatment period . The principal safety end point was major bleeding . RESULTS The annualized rate of the primary end point during treatment was 1.50 % with warfarin ( 
    Output:
    
Conclusion DOACs peri-cardioversion in patients with AF appears safe from both a bleeding and thromboembolic risk perspective .
Available evidence supports the use of DOACs as st and ard of care peri-cardioversion in patients with AF