Arrhythmias and Conduction DisturbancesMeta-Analysis of Efficacy and Safety of New Oral Anticoagulants Compared With Uninterrupted Vitamin K Antagonists in Patients Undergoing Catheter Ablation for Atrial Fibrillation
Section snippets
Methods
PubMed, EMBASE, the Cochrane Library, and Clinicaltrials.gov databases were searched to identify published reports comparing NOACs to uninterrupted VKAs in patients who underwent CA for AF from January 1, 2000, to August 31, 2015. The main key words we used were “atrial fibrillation,” “catheter ablation,” “anticoagulants,” “warfarin,” “dabigatran,” “rivaroxaban,” “apixaban,” “factor Xa inhibitor,” and “factor IIa inhibitor” (refer to Supplementary File 1 for details of search strategy). The
Results
The flowchart of detailed search process was illustrated in Figure 1. From a total of 2,692 potentially relevant reports, 25 citations, involving 11,686 patients, fulfilled selection criteria and were finally included in this meta-analysis.3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27 Of the identified studies, only one was RCT,20 and the remaining were observational studies. Eighteen studies were published as full-text studies,3, 4, 5, 6, 7, 8, 9,
Discussion
The present study was the first and most comprehensive meta-analysis so far comparing the efficacy and safety of NOACs to uninterrupted VKAs in patients undergoing rhythm control management of AF by CA, with 25 selected studies that included 11,686 participants. This meta-analysis incorporating all these studies showed that NOACs, whether discontinued preprocedure or not, had comparable efficacy in terms of ischemic stroke or TIA prevention and similar safety with respect to the occurrence of
Disclosures
The authors have no conflicts of interest to disclose.
References (30)
- et al.
Meta-analysis of major bleeding with uninterrupted warfarin compared to interrupted warfarin and heparin bridging in ablation of atrial fibrillation
Int J Cardiol
(2015) - et al.
Feasibility and safety of dabigatran versus warfarin for periprocedural anticoagulation in patients undergoing radiofrequency ablation for atrial fibrillation
J Am Coll Cardiol
(2012) - et al.
Dabigatran vs warfarin for radiofrequency catheter ablation of atrial fibrillation
Heart Rhythm
(2013) - et al.
Comparison of atrial fibrillation ablation bleeding and thrombotic complications with dabigatran, rivaroxaban and warfarin
J Am Coll Cardiol
(2013) - et al.
Feasibility and safety of uninterrupted periprocedural apixaban administration in patients undergoing radiofrequency catheter ablation for atrial fibrillation: results from a multicenter study
Heart Rhythm
(2015) - et al.
Comparison of safety of left atrial catheter ablation procedures for atrial arrhythmias under continuous anticoagulation with apixaban versus phenprocoumon
Am J Cardiol
(2015) - et al.
Feasibility and safety of uninterrupted rivaroxaban for periprocedural anticoagulation in patients undergoing radiofrequency ablation for atrial fibrillation: results from a multicenter prospective registry
J Am Coll Cardiol
(2014) - et al.
Differences in activated clotting time among uninterrupted anticoagulants during the periprocedural period of atrial fibrillation ablation
Heart Rhythm
(2015) - et al.
Meta-analysis of risk of stroke or transient ischemic attack with dabigatran for atrial fibrillation ablation
Am J Cardiol
(2014) - et al.
Cerebrovascular complication associated with pulmonary vein ablation
J Cardiovasc Electrophysiol
(2002)
Use of dabigatran for periprocedural anticoagulation in patients undergoing catheter ablation for atrial fibrillation
Circ Arrhythm Electrophysiol
Continuous warfarin versus periprocedural dabigatran to reduce stroke and systemic embolism in patients undergoing catheter ablation for atrial fibrillation or left atrial flutter
J Interv Card Electrophysiol
Comparative safety of periablation anticoagulation strategies for atrial fibrillation: data from a large multicenter study
Pacing Clin Electrophysiol
The incidence of asymptomatic cerebral microthromboembolism after atrial fibrillation ablation: comparison of warfarin and dabigatran
Pacing Clin Electrophysiol
Efficacy and safety of periprocedural dabigatran in patients undergoing catheter ablation of atrial fibrillation
Circ J
Cited by (51)
Stroke prevention in atrial fibrillation: State of the art
2019, International Journal of CardiologyCitation Excerpt :In patients using VKA, quality of anticoagulation control is important, and a TTR > 70% should be maintained to improve outcomes [5]. The introduction of the non-vitamin K antagonist anticoagulants (NOACs), including factor II inhibitor, dabigatran, factor X inhibitors, rivaroxaban, apixaban and edoxaban, has changed the landscape of stroke prevention in AF patients worldwide, offering relatively improved efficacy, safety and convenience compared with the traditional VKAs [6–12]. Indeed, all NOACs are associated with a reduced risk for intracranial hemorrhage (ICH), even compared with well-controlled VKAs [13,14].
Non-vitamin K antagonist use in the cryoballoon technique using a purse-string suture closure
2018, International Journal of CardiologyUninterrupted Direct Oral Anticoagulant and Warfarin Administration in Elderly Patients Undergoing Catheter Ablation for Atrial Fibrillation: A Comparison With Younger Patients
2018, JACC: Clinical ElectrophysiologyCitation Excerpt :Currently, uninterrupted vitamin K antagonism during the ablation procedure has been widely accepted to reduce stroke events without increasing bleeding compared with interrupted warfarin treatment (4). Recent studies have also reported that perioperative uninterrupted DOAC use was similarly feasible and safe compared with uninterrupted warfarin treatment (5–15). It is unclear whether these results can be applied to elderly patients who undergo catheter ablation for AF.
See page 933 for disclosure information.