Safety and efficacy of <scp>DOACs</scp> vs acenocoumarol in patients undergoing catheter ablation of atrial fibrillation

Vlachos, Konstantinos; Efremidis, Michael; Bazoukis, George; Letsas, Κonstantinos P.; Saplaouras, Athanasios; Georgopoulos, Stamatis; Karamichalakis, Nikolaos; Rokiza, Aikaterini; Sakellaropoulou, Antigoni; Kolokathis, Angelos Michail; Efremidis, Theodoros; Asvestas, Dimitrios; Sideris, Antonios

doi:10.1002/clc.22734

Cited by 8 publications

(4 citation statements)

References 26 publications

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“…In six studies the risk of bias was low, in two studies (one randomized, one observational) risk of bias was considered moderate ( Supplementary material online, Table S2 ). 10 , 21 …”

Section: Resultsmentioning

confidence: 99%

Meta-analysis of controlled studies on minimally interrupted vs. continuous use of non-vitamin K antagonist oral anticoagulants in catheter ablation for atrial fibrillation

Vugt¹,

Westra²,

Volleberg³

et al. 2021

EP Europace

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Aims At present, there are no guideline recommendations for minimally interrupted use of non-vitamin K antagonist oral anticoagulants (mi-NOAC) during catheter ablation (CA) for atrial fibrillation (AF). Current evidence is predominantly based on observational studies, with continuous use of vitamin K antagonist in the control arm. This quantitative summary reflects the first high-level evidence on contemporary regimens, with continuous NOAC use (c-NOAC) as the current gold standard. Methods and results Meta-analysis (Pubmed, Embase, and Web of Science) on prospective, controlled studies comparing contemporary mi-NOAC (without bridging) with c-NOAC. Net adverse clinical events (major bleeding, thrombo-embolic events) were the primary outcome. In addition, we analysed total bleeding, minor bleeding, and silent cerebral embolism. Eight studies (six randomized, two observational) with 2168 patients were summarized. The primary endpoint occurred in 1.0% (18/1835): 1.1% (11/1005) vs. 0.8% (7/830) for the mi-NOAC and c-NOAC groups, respectively; odds ratio (OR) 1.20 [95% confidence interval (CI) 0.49–2.92, P = 0.64]. The OR for total bleeding on mi-NOAC was 1.26 (95% CI 0.97–1.63, P = 0.07). ORs for minor bleeding and silent cerebral embolism were 1.17 (95% CI 0.80–1.70, P = 0.34) and 2.62 (95% CI 0.54–12.61, P = 0.12), respectively. Conclusion This synopsis provides a quantitative synthesis of high-level evidence on a contemporary strategy of mi-NOAC in CA for AF, and overall clinical outcomes were not different from continuous NOAC use. Despite preprocedural interruption, there was no sign of lower bleeding rates. Additional higher volume datasets are warranted for more precise treatment effect estimations of this everyday alternative anticoagulation strategy in AF ablation.

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“…In six studies the risk of bias was low, in two studies (one randomized, one observational) risk of bias was considered moderate ( Supplementary material online, Table S2 ). 10 , 21 …”

Section: Resultsmentioning

confidence: 99%

Meta-analysis of controlled studies on minimally interrupted vs. continuous use of non-vitamin K antagonist oral anticoagulants in catheter ablation for atrial fibrillation

Vugt¹,

Westra²,

Volleberg³

et al. 2021

EP Europace

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“…A total of 2694 records were identified, of which 29 studies met the predefined criteria and hence were included in the analysis. The detailed search flowchart was illustrated in Figure .…”

Section: Resultsmentioning

confidence: 99%

“…Of note, in that meta‐analysis, the efficacy and safety of interrupted NOACs vs interrupted VKAs were not specifically assessed. Furthermore, several studies have been published recently, among which the AEIOU study published online is a randomized cohort trial . Therefore, we comprehensively collected the published studies comparing NOACs and VKAs to evaluate the safety and efficacy of NOACs in AF patients undergoing catheter ablation and to investigate the differences in uninterrupted NOACs vs uninterrupted VKAs or interrupted NOACs vs interrupted VKAs.…”

Section: Introductionmentioning

confidence: 99%

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

Faggioni

Baber

et al. 2018

Cardiovascular Therapeutics

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“…17 Thus far, there have been several studies evaluating the safety of NOACs in patients undergoing PVI. 12,16,[18][19][20] Most of these studies evaluated different periprocedural anticoagulation management protocols, but commonly they confirm the safe use of NOACs.…”

Section: Minor Complicationsmentioning

confidence: 99%

Apixaban, rivaroxaban, and dabigatran use in patients undergoing catheter ablation for atrial fibrillation using the second‐generation cryoballoon

Tscholl

Lsharaf

Lin

et al. 2017

Clinical Cardiology

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Background Data are limited on the safety of periprocedural anticoagulation with novel oral anticoagulants (NOACs) in patients undergoing pulmonary vein isolation (PVI) using the second‐generation cryoballoon (CB) for the treatment of atrial fibrillation. Hypothesis We hypothesized that the incidence of acute periprocedural complications in patients undergoing PVI do not differ between patients treated with VKA compared to NOACs. Methods In 200 consecutive patients (mean age, 64.3 _ 10.6 years; female, n = 83) with symptomatic atrial fibrillation, PVI using the second‐generation 28‐mm CB was performed. In patients treated with NOACs, the medication was stopped the day of the procedure and continued the evening after the procedure with a reduced dosage. Patients treated with phenprocoumon were continued on uninterrupted phenprocoumon with a target INR of 2 to 3. If INR was <2, bridging with low‐molecular‐weight heparin was performed. Results Forty‐seven of 200 patients (23.5%) were treated with a vitamin K antagonist (VKA) and 55 (27.5%) were treated with apixaban, 67 (33.5%) with rivaroxaban, and 31 (15.5%) with dabigatran. Seven (3.5%) major complications occurred in the overall population. Major bleeding complications did not differ significantly between the 2 groups (P = 0.23). One patient taking VKA had a pericardial tamponade at the end of the procedure; 2 patients treated with apixaban developed a groin hematoma requiring surgical intervention. Transient ischemic attack occurred in 1 patient of the apixaban and rivaroxaban group. Conclusions Apixaban, rivaroxaban, and dabigatran, compared with uninterrupted VKA, did not show a higher risk for major bleeding or ischemic complications in patients undergoing PVI using the second‐generation CB.

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Safety and efficacy of DOACs vs acenocoumarol in patients undergoing catheter ablation of atrial fibrillation

Abstract: DOACs and acenocoumarol have similar safety and effectiveness regarding thromboembolic complications prevention without increasing bleeding complications.

Cited by 8 publications

References 26 publications

Meta-analysis of controlled studies on minimally interrupted vs. continuous use of non-vitamin K antagonist oral anticoagulants in catheter ablation for atrial fibrillation

Meta-analysis of controlled studies on minimally interrupted vs. continuous use of non-vitamin K antagonist oral anticoagulants in catheter ablation for atrial fibrillation

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

Apixaban, rivaroxaban, and dabigatran use in patients undergoing catheter ablation for atrial fibrillation using the second‐generation cryoballoon

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