AI Article Synopsis
- Uninterrupted vitamin K antagonists (VKAs) during atrial fibrillation ablation show better outcomes than bridging with heparin, while studies on uninterrupted new oral anticoagulants (NOACs) are limited and small-scale.
- A meta-analysis of 3544 patients from 8 studies found that the rates of stroke, transient ischemic attacks, and major bleeding were similar between patients using uninterrupted NOACs and those using VKAs during the procedure.
- The research indicates that uninterrupted NOACs are as safe and effective as VKAs for patients undergoing ablation for atrial fibrillation.
Article Abstract
Background: Use of uninterrupted vitamin K antagonists (VKAs) during ablation of atrial fibrillation is superior to bridging with heparin. Few studies evaluated the use of uninterrupted new oral anticoagulants (NOACs) during ablation of atrial fibrillation. These studies are relatively small in size and mostly underpowered to show differences in the infrequent thromboembolic complications between comparators.
Methods: We performed the first meta-analysis of uninterrupted NOAC compared with uninterrupted VKA in ablation of atrial fibrillation. We searched the online databases until May 2015 and report outcomes of interest as odds ratios (ORs) using a random effects model. A total of 3544 atrial fibrillation patients in 8 studies who underwent catheter ablation were included in this analysis.
Results: Overall, stroke and/or transient ischemic attack events were of very low incidence with uninterrupted anticoagulation strategy in 6 of 3544. There were no differences in rates of stroke and/or transient ischemic attack between uninterrupted NOAC and uninterrupted VKA, 0.11% vs 0.22% (OR, 0.65; 95% confidence interval [CI], 0.14-2.96; P = 0.58), nor in major bleeding 0.9% vs 1% (OR, 0.94; 95% CI, 0.48-1.87; P = 0.87). All bleeding 6.5% vs 7.3% (OR, 0.93; 95% CI, 0.67-1.29; P = 0.65), minor bleeding 6.3% vs 7.1% (OR, 0.93; 95% CI, 0.67-1.28), and cardiac tamponade 0.6% vs 0.6% (OR, 1.0; 95% CI, 0.43-2.31; P = 1.0) were all equal with uninterrupted NOACs compared with uninterrupted VKAs. Among 3544 patients, only one death occurred in the VKA group.
Conclusions: Use of uninterrupted NOACs in ablation appears to be as safe and efficacious as use of uninterrupted VKAs.
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| http://dx.doi.org/10.1016/j.cjca.2015.09.012 | DOI Listing |
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