Safety and efficacy of nonvitamin K antagonist oral anticoagulants during catheter ablation of atrial fibrillation: A systematic review and meta‐analysis

Ge, Zhen; Faggioni, Michela; Baber, Usman; Sartori, Samantha; Sorrentino, Sabato; Farhan, Serdar; Chandrasekhar, Jaya; Vogel, Birgit; Qadeer, Abdul; Halperin, Jonathan L.; Reddy, Vivek Y.; Dukkipati, Srinivas R.; Dangas, George; Mehran, Roxana

doi:10.1111/1755-5922.12457

Cited by 11 publications

(6 citation statements)

References 52 publications

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“…A meta-analysis by Wu et al found comparable efficacy and safety of DOACs to warfarin in 11,686 patients undergoing catheter ablation for atrial fibrillation, albeit the risk for minor bleeding was lower with DOACs than warfarin [21]. The DOAC associated reduced risk of bleeding during catheter ablation for atrial fibrillation was also confirmed by Ge et al in a systematic review and meta-analysis involving 12,644 patients [22]. Among DOACs, dabigatran, the first available DOAC, was the least prescribed DOAC.…”

Section: Discussionmentioning

confidence: 81%

Prescribing trends of oral anticoagulants in England over the last decade: a focus on new and old drugs and adverse events reporting

Afzal

Zaidi

Merchant

et al. 2021

J Thromb Thrombolysis

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Direct-acting oral anticoagulants (DOACs) are replacing conventional VKA (vitamin K antagonist, i.e., warfarin) for various indications where a therapeutic anticoagulant effect is desired. We evaluated the prescribing patterns of the DOACs and warfarin, cost implications of the increasing DOACs prescribing, and deduce the reporting of serious and fatal events, during 2009–2019 in primary care England. Prescriptions and fatal or serious adverse events reporting data, between 2009 and 2019 were analysed, using linear regression to examine the trends in prescriptions, costs, and serious and fatal events reporting. We also compared the prescribing trends of four direct-acting oral anticoagulants and warfarin, normalised to per 1000 clinical commissioning group (CCG) patient population for the year 2019 to better understand the regional differences in DOACs prescribing. The overall use of any DOACs (as a proportion of total anticoagulants) increased from 16% in 2015 to 62% in 2019 with an average increase of 87% (95% CI 83.1, 90.5) per year. The reporting of serious and fatal events associated with DOACs decreased by 6% (95% CI 12.5, − 0.1) per year. Apixaban is by far the most prescribed with an average drug cost increasing to 156% (95% CI 140, 172) per year. In England, the lowest anticoagulant prescribing region was Greater London whereas the highest prescribing regions were Yorkshire and Humber for DOACs and the East Midlands for warfarin. Interestingly, Lancashire, Merseyside, and Cheshire showed a higher usage for warfarin over DOACs. The differing prescription patterns could be a result of changes in national guidelines and increasing population. Nevertheless, DOACs appear to make an increasing contribution to total anticoagulant prescription items and costs.

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Section: Discussionmentioning

confidence: 81%

Prescribing trends of oral anticoagulants in England over the last decade: a focus on new and old drugs and adverse events reporting

Afzal

Zaidi

Merchant

et al. 2021

J Thromb Thrombolysis

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“…In the clinical scenarios of catheter ablation and cardioversion procedures, the guidelines reviewed shared similar approaches regarding the use of OAC and NOACs. Several studies have examined the use of uninterrupted NOACs in the catheter ablation setting and all data support better safety profile compared to VKAs, with no differences in terms of efficacy 54,55 . In the cardioversion setting NOACs were similar to VKAs in terms of both efficacy and safety 56 .…”

Section: Summary and Discussionmentioning

confidence: 99%

Stroke Prevention, Evaluation of Bleeding Risk, and Anticoagulant Treatment Management in Atrial Fibrillation Contemporary International Guidelines

Proietti

Lane

Boriani

et al. 2019

Canadian Journal of Cardiology

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“…In four open-label controlled trials investigating the best OAC strategy in subjects undergoing left atrial catheter ablation of AF, the rates of bleeding were lower or comparable with uninterrupted NOACs than with uninterrupted warfarin with target INR 2.0-3.0 [31][32][33][34]. The safety of NOACs in this setting has also been demonstrated in reallife patients [35,36]. Thus, NOACs are a better alternative to well-managed VKAs when catheter ablation of AF is planned.…”

Section: Periprocedural Oral Anticoagulationmentioning

confidence: 93%

Many Good Reasons to Switch from Vitamin K Antagonists to Non-Vitamin K Antagonists in Patients with Non-Valvular Atrial Fibrillation

Botto¹,

Ameri

Caterina

2021

JCM

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Non-vitamin K oral anticoagulants (NOACs) are the first choice for prophylaxis of cardioembolism in patients with non-valvular atrial fibrillation (AF) who are anticoagulant-naïve, as well as the preferable anticoagulation strategy in those who are on vitamin K antagonists (VKAs), but with a low time in therapeutic range (TTR). Nonetheless, there are many good reasons to consider switching from VKAs to NOACs also when TTR is >70%. From the pharmacological standpoint, anticoagulation with VKAs may remain erratic even in those patients who have high TTR values, owing to the mode of action of this drug class. Furthermore, experimental data suggest that, unlike VKAs, NOACs favorably modulate the effects of factor Xa and thrombin in the cardiovascular system through the protease-activated receptor family. Clinically, the most striking advantage provided by NOACs over VKAs, irrespective of the TTR, is the substantially lower risk of intracranial hemorrhage. NOACs have also been associated with less deterioration of renal function as compared with VKAs and may confer protection against cardiovascular events not strictly related to AF, especially the acute complications of peripheral artery disease. In this narrative review, we discuss the evidence according to which it is warranted to systematically substitute NOACs for VKAs for the prevention of AF-related stroke and systemic embolism.

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Safety and efficacy of nonvitamin K antagonist oral anticoagulants during catheter ablation of atrial fibrillation: A systematic review and meta‐analysis

Cited by 11 publications

References 52 publications

Prescribing trends of oral anticoagulants in England over the last decade: a focus on new and old drugs and adverse events reporting

Prescribing trends of oral anticoagulants in England over the last decade: a focus on new and old drugs and adverse events reporting

Stroke Prevention, Evaluation of Bleeding Risk, and Anticoagulant Treatment Management in Atrial Fibrillation Contemporary International Guidelines

Many Good Reasons to Switch from Vitamin K Antagonists to Non-Vitamin K Antagonists in Patients with Non-Valvular Atrial Fibrillation

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