Open AccessSafety and efficacy of nonvitamin K antagonist oral anticoagulants during catheter ablation of atrial fibrillation: A systematic review and meta‐analysis
Author(s) -
Ge Zhen,
Faggioni Michela,
Baber Usman,
Sartori Samantha,
Sorrentino Sabato,
Farhan Serdar,
Chandrasekhar Jaya,
Vogel Birgit,
Qadeer Abdul,
Halperin Jonathan,
Reddy Vivek,
Dukkipati Srinivas,
Dangas George,
Mehran Roxana
Publication year - 2018
Publication title -
cardiovascular therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.818
H-Index - 46
eISSN - 1755-5922
pISSN - 1755-5914
DOI - 10.1111/1755-5922.12457
Subject(s) - medicine , atrial fibrillation , catheter ablation , clinical endpoint , observational study , vitamin k antagonist , cochrane library , stroke (engine) , cardiology , randomized controlled trial , warfarin , mechanical engineering , engineering
Summary Aims Catheter ablation for atrial fibrillation ( AF ) is associated with a transitory increase in the risk of both thromboembolic and bleeding events. Evidence on the use of nonvitamin K antagonist oral anticoagulants ( NOAC s) in patients undergoing AF ablation mostly comes from small observational studies, underpowered to detect differences in clinical outcomes between NOAC s and vitamin K antagonists (VKAs) treated patients. This updated meta‐analysis aimed to determine the safety and efficacy of periprocedural anticoagulation with NOAC s compared with VKAs in AF patients undergoing catheter ablation. Methods We searched MEDLINE , Cochrane library, and web sources for randomized and observational studies comparing periprocedural treatment with NOAC s and VKA s in patients undergoing AF ablation. The primary safety endpoint was major bleeding events, and the primary efficacy endpoint was thromboembolic events (a composite of systemic thromboembolism, transient ischemic attack, and stroke). Results A total of 29 studies with 12 644 patients were included in the meta‐analysis. Overall, patients on NOAC s had a significantly lower risk of major bleeding compared to VKA s either in observational studies (Peto OR 0.68; 95% CI : 0.48‐0.95; P = 0.022; I 2 = 20%) or in RCT s (Peto OR 0.30; 95% CI : 0.14‐0.62; P = 0.001; I 2 = 28%). Uninterrupted NOAC s reduced the risk of major bleeding when compared to uninterrupted VKA s (Peto OR 0.66; 95% CI : 0.45‐0.96; P = 0.028; I 2 = 1%), similarly, interrupted NOAC s lowered the risk of major bleeding compared to interrupted VKA s (Peto OR 0.29; 95% CI : 0.13‐0.66; P = 0.003; I 2 = 0%; P interaction = 0.076). The rate of thromboembolic complications was very low and did not significantly differ between the study groups either in observational studies (Peto OR 0.91; 95% CI : 0.49‐1.67; P = 0.755; I 2 = 0%) or in RCT s (Peto OR 0.14; 95% CI : 0.01‐1.30; P = 0.083; I 2 = 0%). Conclusions Use of NOAC s compared to VKA s significantly reduced the risk of bleeding in patients with AF ablation. Similarly, the risk of bleeding was lower with uninterrupted NOAC s than with uninterrupted VKA s, and with interrupted NOAC s than with interrupted VKA s. The rate of thromboembolic complications was extremely low in both study groups without any differences.