Abstract 12536: Lower Thromboembolic and Bleeding Events With Uninterrupted Warfarin Compared to Interrupted Warfarin and Heparin Bridging in Atrial Fibrillation Ablation. Evidence From a Meta-Analysis

Abstract

Introduction: Optimal anticoagulation strategy in patients undergoing atrial fibrillation ablation (AFA) is controversial. Trials comparing uninterrupted warfarin (UW) with interrupted warfarin and heparin bridging (IW) peri-procedural in AFA are inconsistent in showing decreased thromboembolic and bleeding events with UW. We sought to perform a meta-analysis comparing both strategies in AFA. Methods: We searched online databases till May 2014 for case-control studies that compared patients undergoing AFA with UW versus IW. Studies without a control arm, and those that included patients not on anticoagulation peri-procedural were excluded. We used odds ratio and random effects model. When event rates were less than 1% we used Peto Odds ratio. We explored the hypothesis that UW decreased thromboembolic events with equal bleeding rates compared to IW therapy in patients undergoing AFA. Results: Our search yielded 13 observational and 1 randomized trial. A total of 17628 patients were included, of those 7964 on UW vs 9664 on IW. Patients on UW had lower combined Stroke and TIA compared with IW (Odds ratio (OR) 0.29, 95% confidence interval (CI) [0.12, 0.72]; p=0.007). Consistently Stroke were lower with UW (Peto OR 0.21, 95% CI [0.13, 0.33]; p<0.0001) and TIA (Peto OR 0.25, 95% CI [0.13, 0.51]; p=0.0001). Major bleeding events were also lower with UW (OR 0.73, 95% CI [0.57, 0.94]; p=0.02) as well as minor bleeding (OR 0.36, 95% CI [0.23, 0.56]; p<0.0001) compared to IW. Cardiac tamponade were equal with both strategies (POR 0.84, 95% CI [0.61, 1.16]; p=0.3). Conclusion: In AFA, UW decreases the incidence of stroke and TIA with lower major and minor bleeding events compared to IW. These results recommend use of UW rather than IW strategy in AFA.