Anticoagulation after catheter ablation of atrial fibrillation: An unnecessary evil? A systematic review and meta-analysis

Riccardo Proietti, Ahmed AlTurki, Luigi Di Biase, Paolo China, Giovanni Forleo, Andrea Corrado, Elena Marras, Andrea Natale, Sakis Themistoclakis

Research output: Contribution to journalArticle

Abstract

Background: Anticoagulation in patients with atrial fibrillation (AF) is currently based on clinical parameters (CHA2DS 2-VASc score) that have been shown to predict cerebrovascular events (CVE). Controversy exists as to whether CVE risk persists unmodified after successful catheter ablation, as observational studies suggest a lower risk of CVE. Current guidelines recommend continued oral anticoagulation (OAC) based on the CHA 2DS 2-VASc score risk profile. Methods: We conducted a systematic literature review of all studies published up to July 31, 2018, that reported CVE after catheter ablation of AF and compared patients on or off OAC. Random-effects models were used to demonstrate the risk of CVE and major bleeding in on-OAC vs off-OAC patients. This analysis was further stratified by CHADS2 and CHA 2DS 2-VASc score. Results: We retained 16 studies, 10 prospective cohort and 6 retrospective cohort, that met inclusion criteria, and which enrolled 25 177 patients: 13 166 off-OAC and 12 011 on-OAC. No significant difference in the incidence of CVE emerged between on-OAC and off-OAC patients after AF ablation (risk ratio, 0.66; confidence interval [CI], 0.38, 1.15). Similar results were found after stratification by CHADS2 and CHA 2DS 2-VASc score. Off-OAC patients suffered significantly less bleeding than those on OAC (RR, 0.17; CI, 0.09, 0.34). Of note, the percentage of patients with AF recurrence impacts the treatment effect in the two groups (P = 0.001). Conclusions: In this metanalysis, the risk-benefit ratio favored the suspension of OAT after successful AF ablation even in patients at moderate-high risk. Whether the reported results can be extended also to non-vitamin K antagonist oral anticoagulants warrants further investigations.

LanguageEnglish (US)
JournalJournal of cardiovascular electrophysiology
DOIs
StateAccepted/In press - Jan 1 2019

Fingerprint

Catheter Ablation
Atrial Fibrillation
Meta-Analysis
Odds Ratio
Confidence Intervals
Hemorrhage
Anticoagulants
Observational Studies
Suspensions
Prospective Studies
Guidelines
Recurrence
Incidence

Keywords

  • anticoagulation
  • atrial fibrillation
  • bleeding
  • catheter ablation
  • meta-analysis
  • stroke

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Anticoagulation after catheter ablation of atrial fibrillation : An unnecessary evil? A systematic review and meta-analysis. / Proietti, Riccardo; AlTurki, Ahmed; Di Biase, Luigi; China, Paolo; Forleo, Giovanni; Corrado, Andrea; Marras, Elena; Natale, Andrea; Themistoclakis, Sakis.

In: Journal of cardiovascular electrophysiology, 01.01.2019.

Research output: Contribution to journalArticle

Proietti, Riccardo ; AlTurki, Ahmed ; Di Biase, Luigi ; China, Paolo ; Forleo, Giovanni ; Corrado, Andrea ; Marras, Elena ; Natale, Andrea ; Themistoclakis, Sakis. / Anticoagulation after catheter ablation of atrial fibrillation : An unnecessary evil? A systematic review and meta-analysis. In: Journal of cardiovascular electrophysiology. 2019.
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T1 - Anticoagulation after catheter ablation of atrial fibrillation

T2 - Journal of Cardiovascular Electrophysiology

AU - Proietti, Riccardo

AU - AlTurki, Ahmed

AU - Di Biase, Luigi

AU - China, Paolo

AU - Forleo, Giovanni

AU - Corrado, Andrea

AU - Marras, Elena

AU - Natale, Andrea

AU - Themistoclakis, Sakis

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Anticoagulation in patients with atrial fibrillation (AF) is currently based on clinical parameters (CHA2DS 2-VASc score) that have been shown to predict cerebrovascular events (CVE). Controversy exists as to whether CVE risk persists unmodified after successful catheter ablation, as observational studies suggest a lower risk of CVE. Current guidelines recommend continued oral anticoagulation (OAC) based on the CHA 2DS 2-VASc score risk profile. Methods: We conducted a systematic literature review of all studies published up to July 31, 2018, that reported CVE after catheter ablation of AF and compared patients on or off OAC. Random-effects models were used to demonstrate the risk of CVE and major bleeding in on-OAC vs off-OAC patients. This analysis was further stratified by CHADS2 and CHA 2DS 2-VASc score. Results: We retained 16 studies, 10 prospective cohort and 6 retrospective cohort, that met inclusion criteria, and which enrolled 25 177 patients: 13 166 off-OAC and 12 011 on-OAC. No significant difference in the incidence of CVE emerged between on-OAC and off-OAC patients after AF ablation (risk ratio, 0.66; confidence interval [CI], 0.38, 1.15). Similar results were found after stratification by CHADS2 and CHA 2DS 2-VASc score. Off-OAC patients suffered significantly less bleeding than those on OAC (RR, 0.17; CI, 0.09, 0.34). Of note, the percentage of patients with AF recurrence impacts the treatment effect in the two groups (P = 0.001). Conclusions: In this metanalysis, the risk-benefit ratio favored the suspension of OAT after successful AF ablation even in patients at moderate-high risk. Whether the reported results can be extended also to non-vitamin K antagonist oral anticoagulants warrants further investigations.

AB - Background: Anticoagulation in patients with atrial fibrillation (AF) is currently based on clinical parameters (CHA2DS 2-VASc score) that have been shown to predict cerebrovascular events (CVE). Controversy exists as to whether CVE risk persists unmodified after successful catheter ablation, as observational studies suggest a lower risk of CVE. Current guidelines recommend continued oral anticoagulation (OAC) based on the CHA 2DS 2-VASc score risk profile. Methods: We conducted a systematic literature review of all studies published up to July 31, 2018, that reported CVE after catheter ablation of AF and compared patients on or off OAC. Random-effects models were used to demonstrate the risk of CVE and major bleeding in on-OAC vs off-OAC patients. This analysis was further stratified by CHADS2 and CHA 2DS 2-VASc score. Results: We retained 16 studies, 10 prospective cohort and 6 retrospective cohort, that met inclusion criteria, and which enrolled 25 177 patients: 13 166 off-OAC and 12 011 on-OAC. No significant difference in the incidence of CVE emerged between on-OAC and off-OAC patients after AF ablation (risk ratio, 0.66; confidence interval [CI], 0.38, 1.15). Similar results were found after stratification by CHADS2 and CHA 2DS 2-VASc score. Off-OAC patients suffered significantly less bleeding than those on OAC (RR, 0.17; CI, 0.09, 0.34). Of note, the percentage of patients with AF recurrence impacts the treatment effect in the two groups (P = 0.001). Conclusions: In this metanalysis, the risk-benefit ratio favored the suspension of OAT after successful AF ablation even in patients at moderate-high risk. Whether the reported results can be extended also to non-vitamin K antagonist oral anticoagulants warrants further investigations.

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