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

Zhao, Yating; Lu, Yao; Qin, Yue

doi:10.1016/j.ijcard.2018.06.024

Cited by 21 publications

(10 citation statements)

References 15 publications

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“…Previous studies proved that the patients receiving NOACs enjoyed similar preventive effects and a lower risk of major bleeding [ 12 , 13 , 21 ]. Efficacy and safety have also been highlighted in electrical cardioversion and transcatheter radiofrequency cardiac ablation [ 22 , 23 , 24 ]. The evidence supported that NOACs would be some of the first drug choices in the treatment of non-valvular atrial fibrillation.…”

Section: Discussionmentioning

confidence: 99%

The CHA2DS2-VASc Score Predicts Major Bleeding in Non-Valvular Atrial Fibrillation Patients Who Take Oral Anticoagulants

Lee

Chang

Yeh

et al. 2018

JCM

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Background: Patients with atrial fibrillation (AF) are at a substantial risk of ischemic stroke. The CHA2DS2-VASc score predicts the risk of thromboembolism, but its role in predicting major bleeding in patients taking oral anticoagulants is unclear. Methods: We used the National Health Insurance Research Database (NHIRD) of Taiwan to identify patients with AF from 2010 to 2016. They were divided into four groups according to the oral anticoagulants. The outcomes were ischemic stroke/systemic thromboembolism, and major bleeding. Results: A total of 279,776 patients were identified. Ischemic stroke or systemic embolism events were observed in 1.73%, 3.62%, 4.36%, and 5.02% of the patients in the apixaban, rivaroxaban, dabigatran, and warfarin groups, respectively. Major bleeding was recorded in 1.18%, 2.66%, 3.23%, and 4.70% of the patients in the apixaban, rivaroxaban, dabigatran, and warfarin groups, respectively. The highest rates for both ischemic stroke and bleeding events occurred in the patients with a CHA2DS2-VASc score of five or more. Conclusion: Non-valvular AF patients with high CHA2DS2-VASc scores are susceptible to both systemic thromboembolism and major bleeding. The trend was consistently observed in patients who took non-vitamin K oral anticoagulants (NOACs) or warfarin. NOACs might be potentially more effective in reducing overall events.

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Section: Discussionmentioning

confidence: 99%

The CHA2DS2-VASc Score Predicts Major Bleeding in Non-Valvular Atrial Fibrillation Patients Who Take Oral Anticoagulants

Lee

Chang

Yeh

et al. 2018

JCM

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“…In a meta‐analysis of these four trials comparing NOACs versus VKA, 133 the rate of death were 0.1% versus 0.2%, respectively; ischemic stroke, 0.2% versus 0.2%, respectively; major bleeding, 2.1% versus 4.2%, respectively; and the composite outcome, 2.4% versus 4.6%, respectively. Another meta‐analysis of six randomized studies 134 on uninterrupted NOACs (dabigatran, rivaroxaban, and apixaban) versus uninterrupted VKA revealed that the incidence of major bleeding was significantly lower in the NOAC group (1.68%) than the VKA group (3.80%) (OR = 0.45, 95% CI = 0.26–0.81, p = 0.007); whereas the incidence of ischemic stroke or TIA was low and similar between NOAC (0.21%) and VKA groups (0.21%). Furthermore, the incidence of silent cerebral thromboembolic events (in three studies) was similar between NOAC (14.0%) and VKA groups (13.3%).…”

Section: Management Of Oral Anticoagulants Before During and After Atrial Fibrillation Ablationmentioning

confidence: 99%

2021 Focused update of the 2017 consensus guidelines of the Asia Pacific Heart Rhythm Society (APHRS) on stroke prevention in atrial fibrillation

Chao

Joung

Takahashi

et al. 2021

Journal of Arrhythmia

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The consensus of the Asia Pacific Heart Rhythm Society (APHRS) on stroke prevention in atrial fibrillation (AF) has been published in 2017 which provided useful clinical guidance for cardiologists, neurologists, geriatricians, and general practitioners in Asia‐Pacific region. In these years, many important new data regarding stroke prevention in AF were reported. The Practice Guidelines subcommittee members comprehensively reviewed updated information on stroke prevention in AF, and summarized them in this 2021 focused update of the 2017 consensus guidelines of the APHRS on stroke prevention in AF. We highlighted and focused on several issues, including the importance of AF Better Care (ABC) pathway, the advantages of non–vitamin K antagonist oral anticoagulants (NOACs) for Asians, the considerations of use of NOACs for Asian patients with AF with single 1 stroke risk factor beyond gender, the role of lifestyle factors on stroke risk, the use of oral anticoagulants during the “coronavirus disease 2019” (COVID‐19) pandemic, etc. We fully realize that there are gaps, unaddressed questions, and many areas of uncertainty and debate in the current knowledge of AF, and the physician's decision remains the most important factor in the management of AF.

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“…Several randomised controlled trials (RCTs) and meta‐analyses have compared UI‐NOAC with UI‐VKA before AF ablation 11‐14 . These studies generally showed a similar rate of thromboembolism between both therapies, although the former seemed to have advantages in terms of major bleeding risk.…”

Section: Introductionmentioning

confidence: 99%

Peri‐procedural novel oral anticoagulants dosing strategy during atrial fibrillation ablation: A meta‐analysis

Mao

Wang

Huang

2020

Pacing Clinical Electrophis

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BACKGROUND: Studies indicate that uninterrupted anticoagulation is superior to interrupted anticoagulation in the periprocedural period during catheter ablation of atrial brillation and has better thromboembolic and hemorrhagic outcomes. Conversely, the few studies addressing the safety and e cacy of interrupted direct oral anticoagulant regimens during catheter ablation of atrial brillation are limited by small samples, short follow-up periods, rare events, and variable outcomes. The purpose of this metaanalysis was to compare interrupted and uninterrupted direct oral anticoagulation during catheter ablation of atrial brillation. METHODS: A systematic search into PubMed, EMBASE, and the Cochrane databases were performed and ve studies were selected that directly that directly compared interrupted versus uninterrupted anticoagulation before ablation and reported procedural outcomes and embolic and bleeding events. The primary outcome of the study was major adverse cerebrocardiovascular events which was a composite of stroke/ transient ischemic attacks and major bleedings, total bleeding which was a composite of major and minor bleedings and silent cerebral events. RESULTS The meta-analysis included 840 patients with uninterrupted anticoagulation and 938 patients with interrupted anticoagulation. Median follow-up was 30 days. Baseline parameters were similar between groups. Activated clotting time before rst heparin bolus was signi cantly longer with uninterrupted anticoagulation (P=.006), whereas mean activated clotting time was similar between the 2 groups (P=.19). Total heparin dose needed was signi cantly higher with interrupted anticoagulation (mean,-1.61; 95% CI,-2.67 to-0.55; P=.003). Mean procedure time did not vary between groups (P=.81). Overall complication rates were low, with similar major adverse cerebrocardiovascular event (P=.40) and total bleeding (P=.55) rates between groups. Silent cerebral events were signi cantly more frequent with interrupted anticoagulation (log odds ratio,-0.90; 95% CI,-1.59 to-0.22; P<.01; I 2 , 33%). Rates of major bleeding, minor bleeding, pericardial effusion, cardiac tamponade, and puncture complications were similar between groups. CONCLUSIONS Uninterrupted anticoagulation during atrial brillation ablation has similar bleeding event rates, procedural times, and mean activated clotting times as interrupted anticoagulation, with fewer silent cerebral events.

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

Cited by 21 publications

References 15 publications

The CHA2DS2-VASc Score Predicts Major Bleeding in Non-Valvular Atrial Fibrillation Patients Who Take Oral Anticoagulants

The CHA2DS2-VASc Score Predicts Major Bleeding in Non-Valvular Atrial Fibrillation Patients Who Take Oral Anticoagulants

2021 Focused update of the 2017 consensus guidelines of the Asia Pacific Heart Rhythm Society (APHRS) on stroke prevention in atrial fibrillation

Peri‐procedural novel oral anticoagulants dosing strategy during atrial fibrillation ablation: A meta‐analysis

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