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Withdrawal of oral anticoagulants 3 months after successful radiofrequency catheter ablation in patients with atrial fibrillation: A meta‐analysis
Author(s) -
Deng Liyu,
Xiao Ying,
Hong Huashan
Publication year - 2018
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/pace.13494
Subject(s) - medicine , atrial fibrillation , relative risk , meta analysis , confidence interval , cochrane library , subgroup analysis , randomized controlled trial , radiofrequency ablation , catheter ablation , ablation , cardiology
Background The best anticoagulation therapy for atrial fibrillation (AF) after radiofrequency catheter ablation (RFCA) remains a challenge. Methods A systematic search of PubMed, Ovid, and Cochrane Library was conducted identifying at clinical trials which evaluated the differences between thromboembolism (TE) and hemorrhage in an off‐oral anticoagulants (OACs) treatment group (the observation group) and an on‐OACs treatment group (the control group), at 3 months after successful RFCA. Meta‐analysis was performed using RevMan 5.3 software, and the fixed effect model was used as a relevant statistical model. χ 2 test and I 2 were used to test for the presence of heterogeneity. Subgroup analysis and sensitivity analysis were also performed. Results The results showed no significant differences between two groups in TE (relative risk [RR] 0.82, 95% confidence interval [CI], 0.51–1.33, P = 0.42), and only mild heterogeneity (P = 0.22, I 2 = 29%). No significant differences in TE between two subgroups were found according to < 3 years and ≥ 3 years follow‐up analyses (RR 0.58, 95% CI, 0.26–1.28, P = 0.18; RR 1.00, 95% CI, 0.54–1.85, P = 1.00). Furthermore, there was a lower risk of TE in the observation subgroup (< 60 years) compared to the control group (RR 0.31, 95% CI, 0.12–0.78, P = 0.01). Also, there were no significant differences in TE between two subgroups (≥ 60 years, RR 1.24, 95% CI, 0.67–2.28, P = 0.49 ) . The risk of hemorrhage in the observation group was significantly lower compared to the control group (RR 0.05, 95%CI, 0.02–0.14, P < 0.00001). Conclusions The withdrawal of OACs 3 months after successful radiofrequency catheter ablation for patients with AF may be safe and feasible. It needs to be tested by randomized controlled trial.