5 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

You might also like
Discover & Discuss Important Research

Keeping up-to-date with research can feel impossible, with papers being published faster than you'll ever be able to read them. That's where Researcher comes in: we're simplifying discovery and making important discussions happen. With over 19,000 sources, including peer-reviewed journals, preprints, blogs, universities, podcasts and Live events across 10 research areas, you'll never miss what's important to you. It's like social media, but better. Oh, and we should mention - it's free.

  • Download from Google Play
  • Download from App Store
  • Download from AppInChina

Researcher displays publicly available abstracts and doesn’t host any full article content. If the content is open access, we will direct clicks from the abstracts to the publisher website and display the PDF copy on our platform. Clicks to view the full text will be directed to the publisher website, where only users with subscriptions or access through their institution are able to view the full article.