A meta-analysis of randomized controlled trials of uninterrupted periprocedural anticoagulation strategy in patients undergoing atrial fibrillation catheter ablation

Abstract

BackgroundIn patients undergoing atrial fibrillation (AF) ablation, despite uninterrupted oral anticoagulants (OACs) have been recommended, no consensus has emerged regarding to whether uninterrupted novel oral anticoagulants (NOACs) are superior to uninterrupted vitamin K antagonists (VKAs) for the periprocedural antithrombotic management. This meta-analysis aimed to compare the efficacy and safety of uninterrupted NOACs and uninterrupted VKAs in patients undergoing AF ablation. MethodsDatabases were searched for articles published up to March 20, 2018. Only randomized controlled trials (RCTs) were selected. The data were analyzed with RevMan 5.3 using a fixed-effects method. Results6 RCTs and 1903 patients were included. There was no significant difference between NOACs group and VKAs group in incidence of stroke or TIA (OR = 1.00, 95% CI = 0.23–4.40, P = 1.00), silent cerebral thromboembolic events (OR = 1.09, 95% CI = 0.67–1.75, P = 0.74) or minor bleeding (OR = 1.01, 95% CI = 0.78–1.31, P = 0.93), which were consistent in subgroup analysis of individual NOAC vs. VKAs group. NOACs treatment was associated with reduced risk of major bleeding as compared with VKAs (OR = 0.45, 95% CI = 0.26–0.81, P < 0.01). In the subgroup analyses, only the dabigatran group showed significant lower incidence of major bleeding compared to VKAs group. ConclusionsIn patients undergoing AF ablation, uninterrupted NOACs is as effective as uninterrupted VKAs treatment, uninterrupted dabigatran (150 mg twice daily) may be superior to other uninterrupted OACs strategies.