Uninterrupted direct oral anticoagulants vs. Uninterrupted vitamin K antagonists during catheter ablation of non-valvular atrial fibrillation: A systematic review and meta-analysis of randomized controlled trials

Jorge Romero, Roberto C. Cerrud-Rodriguez, Juan Carlos Diaz, Gregory F. Michaud, Jose Taveras, Isabella Alviz, Vito Grupposo, Luis Cerna, Ricardo Avendano, Saurabh Kumar, Paulus Kirchhof, Andrea Natale, Luigi Di Biase

Research output: Contribution to journalArticle

10 Scopus citations

Abstract

Aims To assess the incremental benefit of uninterrupted direct oral anticoagulants (DOACs) vs. uninterrupted vitamin K antagonists (VKA) for catheter ablation (CA) of non-valvular atrial fibrillation (NVAF) on three primary outcomes: major bleeding, thrombo-embolic events, and minor bleeding. A secondary outcome was post-procedural silent cerebral infarction (SCI) as detected by brain magnetic resonance imaging. Methods and results A systematic review of Medline, Cochrane, and Embase was done to find all randomized controlled trials (RCTs) in which uninterrupted DOACs were compared against uninterrupted VKA for CA of NVAF. A fixed-effect model was used, with the exception of the analysis regarding major bleeding events (I 2 > 25), for which a random effects model was used. The benefit of uninterrupted DOACs over VKA was analysed from four RCTs that enrolled a total of 1716 patients (male: 71.2%) with NVAF. Of these, 1100 patients (64.1%) had paroxysmal atrial fibrillation. No significant benefit was seen in major bleeding events [risk ratio (RR) 0.54, 95% confidence interval (95% CI) 0.29–1.00; P = 0.05]. No significant differences were found in minor bleeding events (RR 1.11, 95% CI 0.82–1.52; P = 0.50), thrombo-embolic events (RR 0.74, 95% CI 0.26–2.11; P = 0.57), or post-procedural SCI (RR 1.06, 95% CI 0.74–1.53; P = 0.74). Conclusion An uninterrupted DOACs strategy for CA of NVAF appears to be as safe as uninterrupted VKA without a significantly increased risk of minor or major bleeding events. There was a trend favouring DOACs in terms of major bleeding. Given their ease of use, fewer drug interactions and a similar security and effectiveness profile, DOACs should be considered first line therapy in patients undergoing CA for NVAF.

Original languageEnglish (US)
Pages (from-to)1612-1620
Number of pages9
JournalEuropace
Volume20
Issue number10
DOIs
StatePublished - 2018

Keywords

  • Atrial fibrillation
  • Catheter ablation
  • Direct oral anticoagulants
  • Meta-analysis
  • Randomized controlled trials
  • Vitamin K antagonists
  • Warfarin

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Fingerprint Dive into the research topics of 'Uninterrupted direct oral anticoagulants vs. Uninterrupted vitamin K antagonists during catheter ablation of non-valvular atrial fibrillation: A systematic review and meta-analysis of randomized controlled trials'. Together they form a unique fingerprint.

  • Cite this