Comparison of Atrial Fibrillation Ablation Bleeding and Thrombotic Complications With Dabigatran, Rivaroxaban and Warfarin

Bernard, Michael L.; Brabham, William W.; Netzler, Peter C.; Rowley, C.P.; Gold, Michael R.; Leman, Robert B.; Sturdivant, J. Lacy; Wharton, J. Marcus; Cuoco, Frank

doi:10.1016/s0735-1097(13)60276-4

Cited by 7 publications

(9 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“… 1.3 ± 1.0 2.8 ± 1.0 D 150 Held 12 h pre-procedure and resumed on post-procedure night Uninterrupted Bassiouny [ 16 ] 2013 Circ EP 376, 623 59, 63 25, 27 57, 55 Abl. – – D 150 1–2 doses held before procedure resumed at conclusion of the procedure Uninterrupted Bernard [ 17 ] 2013 ACC (155, 75) b , 44 (63, 63) b , 67 – (46, 57) b , 50 Abl. – – D 150, R Held within 24 h pre-procedure and restarted within 24 h post-procedure Uninterrupted Ellis [ 18 ] 2012 HRS 61, 110 – – – Abl.…”

Section: Resultsmentioning

confidence: 99%

Efficacy and Safety of Novel Oral Anticoagulants for Atrial Fibrillation Ablation: An Updated Meta-Analysis

et al. 2016

View full text Add to dashboard Cite

IntroductionNovel oral anticoagulants (NOACs) have been approved for prevention of stroke and systemic embolism in patients with non-valvular atrial fibrillation (NVAF). A large number of patients are on NOACs when they present for AF ablation. We intended to evaluate the safety and efficacy of NOACs for AF ablation during the periprocedural period by performing a meta-analysis of trials comparing NOACs with warfarin.MethodsStudies comparing NOACs (dabigatran and rivaroxaban) with warfarin as periprocedural anticoagulants for AF ablation were identified using an electronic search. Primary outcomes were: (1) a composite endpoint of stroke, transient ischemic attack (TIA), peripheral arterial embolism, or silent cerebral lesions on magnetic resonance imaging (MRI) and (2) major bleeding complications. A random effects model was used to pool the safety and efficacy data across all included trials.ResultsWhen compared to warfarin, there was an increased risk of the composite endpoint of stroke, TIA, peripheral arterial embolism, or silent cerebral lesions on MRI with NOACs as periprocedural anticoagulants for AF ablation [odds ratio (OR): 1.69, 95% confidence interval (CI): 1.06–2.68]. Sub-group analysis revealed a higher risk of composite endpoint with dabigatran as a periprocedural anticoagulant for AF ablation (OR: 2.01, 95% CI: 1.19–3.39) whereas the risk was similar with rivaroxaban (OR: 0.90, 95% CI: 0.34–2.41). Sensitivity analysis after excluding silent cerebral lesions on MRI showed there was no increased risk of thromboembolic events with either dabigatran (OR: 1.69, 95% CI: 0.81–3.51) or rivaroxaban (OR: 0.70, 95% CI: 0.12–4.04). Risk of bleeding with NOACs was similar to warfarin (OR: 0.91, 95% CI: 0.62–1.34).ConclusionNOACs are comparable to warfarin in terms of bleeding complications. However, dabigatran therapy is potentially associated with a higher risk of silent cerebral lesions on MRI. The results of this study should be considered as hypothesis-generating and assessed further in prospective randomized clinical studies.Electronic supplementary materialThe online version of this article (doi:10.1007/s40119-016-0061-7) contains supplementary material, which is available to authorized users.

show abstract

Section: Resultsmentioning

confidence: 99%

Efficacy and Safety of Novel Oral Anticoagulants for Atrial Fibrillation Ablation: An Updated Meta-Analysis

et al. 2016

View full text Add to dashboard Cite

show abstract

“…These studies fulfilling our predefined selection criteria involved 7400 patients of which 1994 subjects received rivaroxaban. Of all identified studies, only one 27 was a randomized controlled clinical trial, whereas the remainders were observational retrospective 12 , 13 , 16 , 18 – 26 or prospective 14 , 15 , 17 studies. The vast majority were single-centre observational studies, with the exception of three multicentre studies 14 , 23 , 27 and one based on a national registry.…”

Section: Resultsmentioning

confidence: 99%

“…In the setting of catheter ablation of AF, some small observational studies 12 – 26 and one randomized trial 27 indicated a similar safety and efficacy profile of rivaroxaban compared with warfarin. However, most of these studies comprised only small patient samples and were hence statistically underpowered for rare outcomes, i.e.…”

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of rivaroxaban compared with vitamin K antagonists for peri-procedural anticoagulation in catheter ablation of atrial fibrillation: a systematic review and meta-analysis

et al. 2016

View full text Add to dashboard Cite

Rivaroxaban is increasingly used in patients undergoing catheter ablation of atrial fibrillation (AF). In the absence of large controlled trials, a comprehensive meta-analysis of the literature appears to be the best way to obtain reliable evidence on rare peri-procedural outcomes such as thromboembolic or bleeding events. We aimed to provide a detailed analysis of currently available data on safety and efficacy of peri-procedural rivaroxaban in patients undergoing AF ablation. We performed a systematic search of the English language literature for studies comparing peri-procedural rivaroxaban therapy with vitamin K antagonists (VKAs) and reporting detailed data on bleeding and/or thromboembolic complications. The Peto odds ratio (POR) was used to pool data into a fixed-effect meta-analysis. A total of 7400 patients undergoing catheter ablation were included in 15 observational and 1 randomized studies of which 1994 were receiving rivaroxaban and 5406 VKA. The risk of thromboembolism trended to be lower in the rivaroxaban group [4/1954 vs. 19/5219, POR 0.40, 95% confidence interval (CI), 0.16–1.01, P = 0.052]. Major bleeding events occurred in 23 of 1994 cases (1.15%) in the rivaroxaban and 90 of 5406 (1.66%) in the VKA group (POR 0.74, 95% CI, 0.46–1.21, P = 0.23). A total of 87 minor bleeding events were reported in 1753 patients (4.96%) in the rivaroxaban group and in 165 of 4009 patients (4.12%) in the VKA group (POR 0.84, 95% CI 0.63-1.11, p = 0.22). In patients undergoing AF ablation, rivaroxaban appears to be an effective and safe alternative to VKA.

show abstract

“…It evaluated efficacy and safety of rivaroxaban in AF patients treated with either cardioversion or RFCA. Sixteen studies [ 16 , 17 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 ] are retrospective analyses including patients that had undergone RFCA of AF with periprocedural anticoagulation utilizing warfarin and dabigatran or rivaroxaban. Two studies [ 34 , 35 ] are retrospective analyses including patients that had undergone left atrial RFCA with periprocedural anticoagulation utilizing phenprocoumon and rivaroxaban or apixaban.…”

Section: Resultsmentioning

confidence: 99%

Efficacy and Safety of Non-Vitamin K Antagonist Oral Anticoagulants versus Vitamin K Antagonist Oral Anticoagulants in Patients Undergoing Radiofrequency Catheter Ablation of Atrial Fibrillation: A Meta-Analysis

et al. 2015

View full text Add to dashboard Cite

BackgroundUse of the non-vitamin K antagonist oral anticoagulants (NOACs) is endorsed by current guidelines for stroke prevention in patients with atrial fibrillation (AF). However efficacy and safety of NOACs in patients undergoing catheter ablation (RFCA) of AF has not been well established yet.ObjectivesTo perform a meta-analysis of all studies comparing NOACs and vitamin K antagonist oral anticoagulants (VKAs) in patients undergoing RFCA.Data SourcesStudies were searched for in PubMed and Google Scholar databases.Study Eligibility CriteriaStudies were considered eligible if: they evaluated the clinical impact of NOACs versus VKAs; they specifically analyzed the use of anticoagulants during periprocedural phase of RFCA; they reported clinical outcome data.Study Appraisal and Synthesis Methods25 studies were selected, including 9881 cases. The summary measure used was the risk ratio (RR) with 95% confidence interval (CI). The random-effects or the fixed effect model were used to synthesize results from the selected studies.ResultsThere was no significant difference in thromboembolic complications (RR 1.39; p=0.13). Bleeding complications were significantly lower in the NOACs-treated arm as compared to VKAs (RR=0.67, p<0.001). Interestingly, a larger number of thromboembolic events was found in the VKAs-treated arm in those studies where VKAs had been interrupted during the periprocedural phase (RR=0.68; p=ns). In this same subgroup a significantly higher incidence of both minor (RR=0.54; p=0.002) and major bleeding (RR=0.41; p=0.01) events was recorded. Conversely, the incidence of thromboembolic events in the VKAs-treated arm was significantly lower in those studies with uninterrupted periprocedural anticoagulation treatment (RR=1.89; p=0.02).LimitationsAs with every meta-analysis, no patients-level data were available.Conclusions and ImplicationsThe use of NOACs in patients undergoing RFCA is safe, given the lower incidence of bleedings observed with NOACs. On the other side, periprocedural interruption of VKAs and bridging with heparin is associated with a higher bleeding rate with no significant benefit on onset of thromboembolic events.

show abstract

Comparison of Atrial Fibrillation Ablation Bleeding and Thrombotic Complications With Dabigatran, Rivaroxaban and Warfarin

Cited by 7 publications

References 0 publications

Efficacy and Safety of Novel Oral Anticoagulants for Atrial Fibrillation Ablation: An Updated Meta-Analysis

Efficacy and Safety of Novel Oral Anticoagulants for Atrial Fibrillation Ablation: An Updated Meta-Analysis

Efficacy and safety of rivaroxaban compared with vitamin K antagonists for peri-procedural anticoagulation in catheter ablation of atrial fibrillation: a systematic review and meta-analysis

Efficacy and Safety of Non-Vitamin K Antagonist Oral Anticoagulants versus Vitamin K Antagonist Oral Anticoagulants in Patients Undergoing Radiofrequency Catheter Ablation of Atrial Fibrillation: A Meta-Analysis

Contact Info

Product

Resources

About