An updated meta-analysis of novel oral anticoagulants versus vitamin K antagonists for uninterrupted anticoagulation in atrial fibrillation catheter ablation

Rhanderson Cardoso, Leonardo Knijnik, Aditya Bhonsale, Jared Miller, Guilherme Nasi, Manuel Rivera, Vanessa Blumer, Hugh Calkins

Research output: Contribution to journalArticle

Abstract

Background: Catheter ablation is recommended as a first- or second-line rhythm control therapy for selected patients with atrial fibrillation (AF). There is a wide variability in the periprocedural management of oral anticoagulation in patients undergoing AF ablation. Objective: We aimed to perform an updated meta-analysis of novel oral anticoagulants (NOACs) vs vitamin K antagonists (VKAs) as uninterrupted anticoagulation in patients undergoing AF ablation. Methods: Databases and conference abstracts were searched. Studies were excluded if oral anticoagulants were held at any periprocedural period. The primary outcomes were stroke or transient ischemic attack (TIA) and major bleeding. Results: Twelve studies and 4962 patients were included. Stroke or TIA was rare (NOAC, 0.08%; VKA, 0.16%) and not different between groups (odds ratio [OR] 0.66; 95% confidence interval [CI] 0.19-2.30). The incidence of silent cerebral embolic events was also not significantly different between NOACs (8%) and VKAs (9.6%) (OR 0.86; 95% CI 0.42-1.76). Major bleeding was significantly reduced in the NOAC group (0.9%) as compared with VKA-treated patients (2%) (OR 0.50; 95% CI 0.30-0.84; P < .01). This finding was confirmed in a subgroup analysis of randomized and cohort studies with matched controls (OR 0.45; 95% CI 0.24-0.83; P = .01). There was no significant difference in the outcomes of individual NOACs and VKAs, although these analyses may have been underpowered to detect minor differences in such rare outcomes. Conclusion: In patients undergoing AF ablation, uninterrupted periprocedural NOACs are associated with a low incidence of stroke or TIA and a significant reduction in major bleeding as compared with uninterrupted VKAs.

Original languageEnglish (US)
JournalHeart Rhythm
DOIs
StateAccepted/In press - 2017

Fingerprint

Catheter Ablation
Vitamin K
Anticoagulants
Atrial Fibrillation
Meta-Analysis
Transient Ischemic Attack
Odds Ratio
Confidence Intervals
Stroke
Hemorrhage
Incidence
Cohort Studies
Databases

Keywords

  • Atrial fibrillation
  • Catheter ablation
  • Major bleeding
  • Novel oral anticoagulants
  • Stroke
  • Vitamin K antagonists

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

An updated meta-analysis of novel oral anticoagulants versus vitamin K antagonists for uninterrupted anticoagulation in atrial fibrillation catheter ablation. / Cardoso, Rhanderson; Knijnik, Leonardo; Bhonsale, Aditya; Miller, Jared; Nasi, Guilherme; Rivera, Manuel; Blumer, Vanessa; Calkins, Hugh.

In: Heart Rhythm, 2017.

Research output: Contribution to journalArticle

Cardoso, Rhanderson ; Knijnik, Leonardo ; Bhonsale, Aditya ; Miller, Jared ; Nasi, Guilherme ; Rivera, Manuel ; Blumer, Vanessa ; Calkins, Hugh. / An updated meta-analysis of novel oral anticoagulants versus vitamin K antagonists for uninterrupted anticoagulation in atrial fibrillation catheter ablation. In: Heart Rhythm. 2017.
@article{7e2c38dfd57840ae99e94a881832c19d,
title = "An updated meta-analysis of novel oral anticoagulants versus vitamin K antagonists for uninterrupted anticoagulation in atrial fibrillation catheter ablation",
abstract = "Background: Catheter ablation is recommended as a first- or second-line rhythm control therapy for selected patients with atrial fibrillation (AF). There is a wide variability in the periprocedural management of oral anticoagulation in patients undergoing AF ablation. Objective: We aimed to perform an updated meta-analysis of novel oral anticoagulants (NOACs) vs vitamin K antagonists (VKAs) as uninterrupted anticoagulation in patients undergoing AF ablation. Methods: Databases and conference abstracts were searched. Studies were excluded if oral anticoagulants were held at any periprocedural period. The primary outcomes were stroke or transient ischemic attack (TIA) and major bleeding. Results: Twelve studies and 4962 patients were included. Stroke or TIA was rare (NOAC, 0.08{\%}; VKA, 0.16{\%}) and not different between groups (odds ratio [OR] 0.66; 95{\%} confidence interval [CI] 0.19-2.30). The incidence of silent cerebral embolic events was also not significantly different between NOACs (8{\%}) and VKAs (9.6{\%}) (OR 0.86; 95{\%} CI 0.42-1.76). Major bleeding was significantly reduced in the NOAC group (0.9{\%}) as compared with VKA-treated patients (2{\%}) (OR 0.50; 95{\%} CI 0.30-0.84; P < .01). This finding was confirmed in a subgroup analysis of randomized and cohort studies with matched controls (OR 0.45; 95{\%} CI 0.24-0.83; P = .01). There was no significant difference in the outcomes of individual NOACs and VKAs, although these analyses may have been underpowered to detect minor differences in such rare outcomes. Conclusion: In patients undergoing AF ablation, uninterrupted periprocedural NOACs are associated with a low incidence of stroke or TIA and a significant reduction in major bleeding as compared with uninterrupted VKAs.",
keywords = "Atrial fibrillation, Catheter ablation, Major bleeding, Novel oral anticoagulants, Stroke, Vitamin K antagonists",
author = "Rhanderson Cardoso and Leonardo Knijnik and Aditya Bhonsale and Jared Miller and Guilherme Nasi and Manuel Rivera and Vanessa Blumer and Hugh Calkins",
year = "2017",
doi = "10.1016/j.hrthm.2017.09.011",
language = "English (US)",
journal = "Heart Rhythm",
issn = "1547-5271",
publisher = "Elsevier",

}

TY - JOUR

T1 - An updated meta-analysis of novel oral anticoagulants versus vitamin K antagonists for uninterrupted anticoagulation in atrial fibrillation catheter ablation

AU - Cardoso, Rhanderson

AU - Knijnik, Leonardo

AU - Bhonsale, Aditya

AU - Miller, Jared

AU - Nasi, Guilherme

AU - Rivera, Manuel

AU - Blumer, Vanessa

AU - Calkins, Hugh

PY - 2017

Y1 - 2017

N2 - Background: Catheter ablation is recommended as a first- or second-line rhythm control therapy for selected patients with atrial fibrillation (AF). There is a wide variability in the periprocedural management of oral anticoagulation in patients undergoing AF ablation. Objective: We aimed to perform an updated meta-analysis of novel oral anticoagulants (NOACs) vs vitamin K antagonists (VKAs) as uninterrupted anticoagulation in patients undergoing AF ablation. Methods: Databases and conference abstracts were searched. Studies were excluded if oral anticoagulants were held at any periprocedural period. The primary outcomes were stroke or transient ischemic attack (TIA) and major bleeding. Results: Twelve studies and 4962 patients were included. Stroke or TIA was rare (NOAC, 0.08%; VKA, 0.16%) and not different between groups (odds ratio [OR] 0.66; 95% confidence interval [CI] 0.19-2.30). The incidence of silent cerebral embolic events was also not significantly different between NOACs (8%) and VKAs (9.6%) (OR 0.86; 95% CI 0.42-1.76). Major bleeding was significantly reduced in the NOAC group (0.9%) as compared with VKA-treated patients (2%) (OR 0.50; 95% CI 0.30-0.84; P < .01). This finding was confirmed in a subgroup analysis of randomized and cohort studies with matched controls (OR 0.45; 95% CI 0.24-0.83; P = .01). There was no significant difference in the outcomes of individual NOACs and VKAs, although these analyses may have been underpowered to detect minor differences in such rare outcomes. Conclusion: In patients undergoing AF ablation, uninterrupted periprocedural NOACs are associated with a low incidence of stroke or TIA and a significant reduction in major bleeding as compared with uninterrupted VKAs.

AB - Background: Catheter ablation is recommended as a first- or second-line rhythm control therapy for selected patients with atrial fibrillation (AF). There is a wide variability in the periprocedural management of oral anticoagulation in patients undergoing AF ablation. Objective: We aimed to perform an updated meta-analysis of novel oral anticoagulants (NOACs) vs vitamin K antagonists (VKAs) as uninterrupted anticoagulation in patients undergoing AF ablation. Methods: Databases and conference abstracts were searched. Studies were excluded if oral anticoagulants were held at any periprocedural period. The primary outcomes were stroke or transient ischemic attack (TIA) and major bleeding. Results: Twelve studies and 4962 patients were included. Stroke or TIA was rare (NOAC, 0.08%; VKA, 0.16%) and not different between groups (odds ratio [OR] 0.66; 95% confidence interval [CI] 0.19-2.30). The incidence of silent cerebral embolic events was also not significantly different between NOACs (8%) and VKAs (9.6%) (OR 0.86; 95% CI 0.42-1.76). Major bleeding was significantly reduced in the NOAC group (0.9%) as compared with VKA-treated patients (2%) (OR 0.50; 95% CI 0.30-0.84; P < .01). This finding was confirmed in a subgroup analysis of randomized and cohort studies with matched controls (OR 0.45; 95% CI 0.24-0.83; P = .01). There was no significant difference in the outcomes of individual NOACs and VKAs, although these analyses may have been underpowered to detect minor differences in such rare outcomes. Conclusion: In patients undergoing AF ablation, uninterrupted periprocedural NOACs are associated with a low incidence of stroke or TIA and a significant reduction in major bleeding as compared with uninterrupted VKAs.

KW - Atrial fibrillation

KW - Catheter ablation

KW - Major bleeding

KW - Novel oral anticoagulants

KW - Stroke

KW - Vitamin K antagonists

UR - http://www.scopus.com/inward/record.url?scp=85032197395&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85032197395&partnerID=8YFLogxK

U2 - 10.1016/j.hrthm.2017.09.011

DO - 10.1016/j.hrthm.2017.09.011

M3 - Article

JO - Heart Rhythm

JF - Heart Rhythm

SN - 1547-5271

ER -