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Peri‐procedural novel oral anticoagulants dosing strategy during atrial fibrillation ablation: A meta‐analysis
Author(s) -
Mao YinJun,
Wang Hang,
Huang PinFang
Publication year - 2020
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.14040
Subject(s) - medicine , atrial fibrillation , odds ratio , stroke (engine) , meta analysis , cochrane library , perioperative , confidence interval , randomized controlled trial , dosing , observational study , oral anticoagulant , anesthesia , warfarin , mechanical engineering , engineering
Background This study aimed at determining whether uninterrupted novel oral anticoagulant (UI‐NOAC) would have similar rates of bleeding and thromboembolic events as minimally interrupted NOAC (MI‐NOAC) at the time of ablation for atrial fibrillation (AF) as relevant studies are scarce. Methods We searched through the PubMed, EMBASE, and Cochrane Library databases for prospective observational studies (POSs) or randomised controlled trials (RCTs) comparing UI‐NOAC versus MI‐NOAC from their establishment to January 2020. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated to compare the pooled treatment effect. Results Nine studies (three POSs and six RCTs) with 2578 patients were included in the final analysis (55% patients received MI‐NOAC). No significant difference was found regarding the risk of major bleeding (OR 0.92, 95% CI 0.43‐2.00, P = .84, I 2 = 0%). Both groups were comparable in all subgroups ([Asians: OR 1.00, 95% CI 0.43‐2.36, P = .99, I 2 = 0%], [non‐Asians: OR 0.64, 95% CI 0.11‐3.88, P = .63, I 2 = 0%], [RCTs: OR 0.85, 95% CI 0.37‐1.97, P = .71, I 2 = 0%], and [POSs: OR 0.52, 95% CI 0.19‐12.01, P = .69, I 2 = 0%]). The risk of minor bleeding ( P = .88) or stroke ( P = .69) was comparable between the groups. UI‐NOAC resulted in a significant reduction in silent stroke (SS) (OR 0.44, 95% CI 0.23‐0.83, P = .01, I 2 = 72%). No significant difference was found in SS between once‐daily and twice‐daily NOACs (OR 0.91, 95% CI 0.63‐1.33, P = .64, I 2 = 0%) in the MI‐NOAC group. Conclusions UI‐NOAC, as a peri‐procedural anticoagulation strategy for catheter ablation in AF, had similar safety compared with MI‐NOAC, but was advantageous in terms of SS.