3 years ago

An Updated Meta-Analysis of Novel Oral Anticoagulants versus Vitamin K Antagonists for Uninterrupted Anticoagulation in Atrial Fibrillation Catheter Ablation

Catheter ablation is recommended as a first or second-line rhythm control therapy for selected patients with atrial fibrillation (AF). There is a wide variability in the periprocedural management of oral anticoagulation for patients undergoing AF ablation. Objective We aimed to perform an updated meta-analysis of novel oral anticoagulants (NOACs) vs. vitamin K antagonists (VKAs) as uninterrupted anticoagulation for patients undergoing AF ablation. Methods Databases and conference abstracts were searched. Studies were excluded if oral anticoagulants were held at any periprocedural period. The primary outcomes were stroke or transient ischemic attacks (TIA) and major bleeding. Results Twelve studies and 4,962 patients were included. Stroke or TIA were very rare (NOAC, 0.08%; VKA, 0.16%) and not different between groups (OR 0.66; 95% CI 0.19-2.30). The incidence of silent cerebral embolic events was also not significantly different between NOACs (8%) and VKAs (9.6%) (OR 0.86; 95% CI 0.42-1.76). Major bleeding was significantly reduced in the NOAC group (0.9%) as compared to VKA-treated patients (2%) (OR 0.50; 95% CI 0.30-0.84; p<0.01). This finding was confirmed in a subgroup analysis of randomized and cohort studies with matched controls (OR 0.45; 95% CI 0.24-0.83; p=0.01). There was no significant difference in the outcomes of individual NOACs vs. VKAs, although these analyses may have been underpowered to detect minor differences in such rare outcomes. Conclusions In patients undergoing AF ablation, uninterrupted periprocedural NOACs are associated with a very low incidence of stroke or TIA and a significant reduction in major bleeding as compared to uninterrupted VKAs.

Publisher URL: www.sciencedirect.com/science

DOI: S1547527117310901

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