Oral anticoagulation after catheter ablation of atrial fibrillation and the associated risk of thromboembolic events and intracranial hemorrhage: A systematic review and meta-analysis

Jorge Romero, Roberto C. Cerrud-Rodriguez, Juan C. Diaz, Daniel Rodriguez, Samiullah Arshad, Isabella Alviz, Luis Cerna, Saul Rios, Sangamitra Monhanty, Andrea Natale, Mario J. Garcia, Luigi Di Biase

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Aims: We sought to examine whether continuing oral anticoagulation (OAC) after catheter ablation (CA) for atrial fibrillation (AF) is associated with improved outcomes. OAC reduces morbidity and mortality in patients with AF. However, the continuation of OAC following the blanking period of CA is controversial due to conflicting published data. Methods: A systematic review of Medline, Cochrane, and Embase was performed for studies comparing patients who were continued on OAC (ON-OAC) vs those in which OAC was discontinued (OFF-OAC). CHA2DS2 VASc score had to be available for the classification of patients into high- or low-risk cohorts (CHA2DS2 VASc ≥ 2 and ≤ 1, respectively). The primary efficacy outcome was thromboembolic events (TE). Intracranial hemorrhage (ICH) was the primary safety outcome. Results: Five studies comprising 3956 patients were included (mean age, 61.1 ± 2.9 years; 72.4% male, CHA2DS2 VASc ≤ 1 50.1%; CHA2DS2 VASc ≥ 2 49.9%). After a mean follow-up of 39.6 ± 11.7 months, OAC-continuation was associated with a significant decrease in risk of TE in the high-risk cohort (CHA2DS2 VASc ≥ 2) (risk ratio [RR] 0.41, 95% confidence interval [CI] 0.21-0.82, P =.01) with a RR reduction of 59%. ICH was significantly higher in the ON-OAC group (RR, 5.78; 95% CI, 1.33-25.08; P =.02). No significant benefit was observed in the low-risk cohort ON-OAC after the blanking period. Conclusion: Continuation of OAC after CA of AF with CHA2DS2 VASc ≥ 2 is associated with a significant decreased TE risk and a favorable net clinical benefit in spite of ICH being significantly increased in the ON-OAC group. Continued OAC offers no benefit with CHA2DS2VASC ≤ 1.

Original languageEnglish (US)
Pages (from-to)1250-1257
Number of pages8
JournalJournal of Cardiovascular Electrophysiology
Volume30
Issue number8
DOIs
StatePublished - Jan 1 2019

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Catheter Ablation
Intracranial Hemorrhages
Atrial Fibrillation
Meta-Analysis
Odds Ratio
Confidence Intervals
Risk Reduction Behavior
Morbidity
Safety
Mortality

Keywords

  • atrial fibrillation
  • catheter ablation
  • intracranial hemorrhage
  • oral anticoagulation
  • thromboembolic events

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Oral anticoagulation after catheter ablation of atrial fibrillation and the associated risk of thromboembolic events and intracranial hemorrhage : A systematic review and meta-analysis. / Romero, Jorge; Cerrud-Rodriguez, Roberto C.; Diaz, Juan C.; Rodriguez, Daniel; Arshad, Samiullah; Alviz, Isabella; Cerna, Luis; Rios, Saul; Monhanty, Sangamitra; Natale, Andrea; Garcia, Mario J.; Di Biase, Luigi.

In: Journal of Cardiovascular Electrophysiology, Vol. 30, No. 8, 01.01.2019, p. 1250-1257.

Research output: Contribution to journalArticle

Romero, Jorge ; Cerrud-Rodriguez, Roberto C. ; Diaz, Juan C. ; Rodriguez, Daniel ; Arshad, Samiullah ; Alviz, Isabella ; Cerna, Luis ; Rios, Saul ; Monhanty, Sangamitra ; Natale, Andrea ; Garcia, Mario J. ; Di Biase, Luigi. / Oral anticoagulation after catheter ablation of atrial fibrillation and the associated risk of thromboembolic events and intracranial hemorrhage : A systematic review and meta-analysis. In: Journal of Cardiovascular Electrophysiology. 2019 ; Vol. 30, No. 8. pp. 1250-1257.
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abstract = "Aims: We sought to examine whether continuing oral anticoagulation (OAC) after catheter ablation (CA) for atrial fibrillation (AF) is associated with improved outcomes. OAC reduces morbidity and mortality in patients with AF. However, the continuation of OAC following the blanking period of CA is controversial due to conflicting published data. Methods: A systematic review of Medline, Cochrane, and Embase was performed for studies comparing patients who were continued on OAC (ON-OAC) vs those in which OAC was discontinued (OFF-OAC). CHA2DS2 VASc score had to be available for the classification of patients into high- or low-risk cohorts (CHA2DS2 VASc ≥ 2 and ≤ 1, respectively). The primary efficacy outcome was thromboembolic events (TE). Intracranial hemorrhage (ICH) was the primary safety outcome. Results: Five studies comprising 3956 patients were included (mean age, 61.1 ± 2.9 years; 72.4{\%} male, CHA2DS2 VASc ≤ 1 50.1{\%}; CHA2DS2 VASc ≥ 2 49.9{\%}). After a mean follow-up of 39.6 ± 11.7 months, OAC-continuation was associated with a significant decrease in risk of TE in the high-risk cohort (CHA2DS2 VASc ≥ 2) (risk ratio [RR] 0.41, 95{\%} confidence interval [CI] 0.21-0.82, P =.01) with a RR reduction of 59{\%}. ICH was significantly higher in the ON-OAC group (RR, 5.78; 95{\%} CI, 1.33-25.08; P =.02). No significant benefit was observed in the low-risk cohort ON-OAC after the blanking period. Conclusion: Continuation of OAC after CA of AF with CHA2DS2 VASc ≥ 2 is associated with a significant decreased TE risk and a favorable net clinical benefit in spite of ICH being significantly increased in the ON-OAC group. Continued OAC offers no benefit with CHA2DS2VASC ≤ 1.",
keywords = "atrial fibrillation, catheter ablation, intracranial hemorrhage, oral anticoagulation, thromboembolic events",
author = "Jorge Romero and Cerrud-Rodriguez, {Roberto C.} and Diaz, {Juan C.} and Daniel Rodriguez and Samiullah Arshad and Isabella Alviz and Luis Cerna and Saul Rios and Sangamitra Monhanty and Andrea Natale and Garcia, {Mario J.} and {Di Biase}, Luigi",
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T1 - Oral anticoagulation after catheter ablation of atrial fibrillation and the associated risk of thromboembolic events and intracranial hemorrhage

T2 - A systematic review and meta-analysis

AU - Romero, Jorge

AU - Cerrud-Rodriguez, Roberto C.

AU - Diaz, Juan C.

AU - Rodriguez, Daniel

AU - Arshad, Samiullah

AU - Alviz, Isabella

AU - Cerna, Luis

AU - Rios, Saul

AU - Monhanty, Sangamitra

AU - Natale, Andrea

AU - Garcia, Mario J.

AU - Di Biase, Luigi

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Aims: We sought to examine whether continuing oral anticoagulation (OAC) after catheter ablation (CA) for atrial fibrillation (AF) is associated with improved outcomes. OAC reduces morbidity and mortality in patients with AF. However, the continuation of OAC following the blanking period of CA is controversial due to conflicting published data. Methods: A systematic review of Medline, Cochrane, and Embase was performed for studies comparing patients who were continued on OAC (ON-OAC) vs those in which OAC was discontinued (OFF-OAC). CHA2DS2 VASc score had to be available for the classification of patients into high- or low-risk cohorts (CHA2DS2 VASc ≥ 2 and ≤ 1, respectively). The primary efficacy outcome was thromboembolic events (TE). Intracranial hemorrhage (ICH) was the primary safety outcome. Results: Five studies comprising 3956 patients were included (mean age, 61.1 ± 2.9 years; 72.4% male, CHA2DS2 VASc ≤ 1 50.1%; CHA2DS2 VASc ≥ 2 49.9%). After a mean follow-up of 39.6 ± 11.7 months, OAC-continuation was associated with a significant decrease in risk of TE in the high-risk cohort (CHA2DS2 VASc ≥ 2) (risk ratio [RR] 0.41, 95% confidence interval [CI] 0.21-0.82, P =.01) with a RR reduction of 59%. ICH was significantly higher in the ON-OAC group (RR, 5.78; 95% CI, 1.33-25.08; P =.02). No significant benefit was observed in the low-risk cohort ON-OAC after the blanking period. Conclusion: Continuation of OAC after CA of AF with CHA2DS2 VASc ≥ 2 is associated with a significant decreased TE risk and a favorable net clinical benefit in spite of ICH being significantly increased in the ON-OAC group. Continued OAC offers no benefit with CHA2DS2VASC ≤ 1.

AB - Aims: We sought to examine whether continuing oral anticoagulation (OAC) after catheter ablation (CA) for atrial fibrillation (AF) is associated with improved outcomes. OAC reduces morbidity and mortality in patients with AF. However, the continuation of OAC following the blanking period of CA is controversial due to conflicting published data. Methods: A systematic review of Medline, Cochrane, and Embase was performed for studies comparing patients who were continued on OAC (ON-OAC) vs those in which OAC was discontinued (OFF-OAC). CHA2DS2 VASc score had to be available for the classification of patients into high- or low-risk cohorts (CHA2DS2 VASc ≥ 2 and ≤ 1, respectively). The primary efficacy outcome was thromboembolic events (TE). Intracranial hemorrhage (ICH) was the primary safety outcome. Results: Five studies comprising 3956 patients were included (mean age, 61.1 ± 2.9 years; 72.4% male, CHA2DS2 VASc ≤ 1 50.1%; CHA2DS2 VASc ≥ 2 49.9%). After a mean follow-up of 39.6 ± 11.7 months, OAC-continuation was associated with a significant decrease in risk of TE in the high-risk cohort (CHA2DS2 VASc ≥ 2) (risk ratio [RR] 0.41, 95% confidence interval [CI] 0.21-0.82, P =.01) with a RR reduction of 59%. ICH was significantly higher in the ON-OAC group (RR, 5.78; 95% CI, 1.33-25.08; P =.02). No significant benefit was observed in the low-risk cohort ON-OAC after the blanking period. Conclusion: Continuation of OAC after CA of AF with CHA2DS2 VASc ≥ 2 is associated with a significant decreased TE risk and a favorable net clinical benefit in spite of ICH being significantly increased in the ON-OAC group. Continued OAC offers no benefit with CHA2DS2VASC ≤ 1.

KW - atrial fibrillation

KW - catheter ablation

KW - intracranial hemorrhage

KW - oral anticoagulation

KW - thromboembolic events

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