The ideal oral anticoagulant agent during catheter ablation (CA) for atrial fibrillation (AF) remained unclear.
Novel oral anticoagulants (NOACs) are safer and effective compared to uninterrupted vitamin K antagonists (U-VKA) among patients requiring CA for AF .
Four randomized controlled trials (RCTs) and 9 observational studies (OS) were selected using PubMed/Medline, EMBASE and the CENTRAL data bases (Inception-December-2017). Estimates were reported as random effects risk ratio (RR) with 95% confidence interval (CI). The primary safety outcome was major bleeding and main efficacy endpoint was thromboembolism.
In RCTs restricted analysis, NOACs significantly reduced the relative risk of major bleeding by 72% compared to U-VKA (RR, 0.28, 95% CI, 0.14–0.58, P < 0.001). This significant effect was not achieved in OS based analysis (RR, 0.86, 95% CI, 0.42–1.78, P = 0.68). In terms of thromboembolism, both anticoagulation strategies were equally effective in analysis of RCTs (RR, 0.28, 95% CI, 0.05–1.70, P = 0.17) or OS (RR, 1.43, 95% CI, 0.46–4.39,P = 0.54). In sensitivity analysis, there was no difference among uninterrupted NOACs (U-NOACs) and U-VKA in terms of major bleeding [(RCTs: RR, 0.33, 95% CI, 0.10–1.06, P = 0.06); (OS: RR, 0.70, 95% CI, 0.28–1.78, P= 0.46)] or thromboembolism [(RCTs: RR, 0.25, 95% CI, 0.03–2.29, P = 0.22); (OS: RR, 0.68, 95% CI, 0.08–5.53, P = 0.72)].
NOACs, either interrupted or un-interrupted, are safer and equally effective drugs compared to U-VKA in AF patients requiring CA.
- We stratified meta-analysis based on study design (RCT and OS).
- Compared the safety and efficacy of NOACs (either interrupted or uninterrupted) with U-VKA in patients undergoing CA for AF
- In analysis of RCTs, NOACs showed significant 72% relative risk reduction in major bleeding compared with U-VKA.
- For thromboembolism, both anticoagulation strategies showed non-significant differences in analysis of RCTs or OS.
- There were no differences in minor bleeding, cardiac tamponade or intracranial complications between both treatment arms.
Cardiovascular Revascularization Medicine, 2019-02-01, Volume 20, Issue 2, Pages 147-152, Copyright © 2018 Elsevier Inc.
Read the original article on Science Direct: Meta-analysis of safety and efficacy of oral anticoagulants in patients requiring catheter ablation for atrial fibrillation