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Interrupted or Uninterrupted Oral Anticoagulants in Patients Undergoing Atrial Fibrillation Ablation

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Abstract

Background and Purpose

The safety and efficacy of uninterrupted, minimally interrupted (one dose skipped) or completely interrupted (24 h skipped) oral anticoagulant therapy in patients with atrial fibrillation (AF) ablation are poorly defined. We conducted a network meta-analysis to explore the effect of interrupted or uninterrupted oral anticoagulants in patients with AF undergoing ablation.

Methods

The Cochrane Library, PubMed and Embase databases were systematically searched for studies comparing uninterrupted, minimally interrupted or completely interrupted non-vitamin K antagonist oral anticoagulants (NOACs) with continuous or interrupted warfarin in patients undergoing AF ablation.

Results

Twelve randomized clinical trials (RCTs) with a total of 5597 patients with AF undergoing catheter ablation were included. For thromboembolism, minimally interrupted NOACs (OR 0.03, 95% CI 0.01–0.35), uninterrupted NOACs (OR 0.04, 95% CI 0.01–0.23) and continuous VKAs (OR 0.05, 95% CI 0.01–0.21) were better than interrupted warfarin. The risk of total bleeding appeared higher in the completely interrupted NOAC group compared with the minimally interrupted NOACs (OR 2.74, 95% CI 1.18–6.37), uninterrupted NOACs (OR 2.15, 95% CI 1.05–4.38) and uninterrupted warfarin (OR 2.04, 95% CI 1.02–4.08). To reduce the risk of total bleeding, minimally interrupted NOACs (OR 0.15, 95% CI 0.08–0.27), uninterrupted NOACs (OR 0.19, 95% CI 0.14–0.42) and uninterrupted warfarin (OR 0.24, 95% CI 0.15–0.39) were better than interrupted warfarin. In the event of major bleeding, there was no significant difference in the interrupted NOAC, uninterrupted NOAC, interrupted VKA and uninterrupted VKA groups.

Conclusions

These three NOAC strategies may have similar safety and efficacy in terms of thromboembolism and major bleeding complications. The total bleeding risk of completely interrupted oral anticoagulants is higher than that of uninterrupted and minimally interrupted NOACs. For thromboembolism, minimally interrupted NOACs, uninterrupted NOACs and continuous VKAs were better than interrupted warfarin.

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Funding

This work was supported by the Provincial Plans - Social Development Areas - Major Projects of Jiangxi Province (No. 20161ACG70012), the Jiangxi Graduate Innovation Special Fund (No. YC2019-B039), and the State Scholarship Fund of the China Scholarship Council (grant number 201906820003).

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Author notes

  1. Pingping Yang, Chenxi Wang, Yinquan Ye and Tieqiu Huang contributed equally to this work.

Authors and Affiliations

  1. Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, No. 1, Minde Road, Donghu District, Nanchang, 330006, Jiangxi, People’s Republic of China

    Pingping Yang, Chenxi Wang, Yinquan Ye, Tieqiu Huang, Shuai Yang, Wen Shen & Qinghua Wu

  2. Department of Radiology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People’s Republic of China

    Yinquan Ye

  3. Department of Nephrology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People’s Republic of China

    Gaosi Xu

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Contributions

Y-PP, W-CX and Y-YQ performed the meta-analysis; H-TQ and Y-S were responsible for the statistical analysis; S-W and X-GS provided editing assistance; and W-QH prepared the manuscript. All the authors have reviewed and agreed to this information before submission.

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Correspondence to Qinghua Wu.

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Yang, P., Wang, C., Ye, Y. et al. Interrupted or Uninterrupted Oral Anticoagulants in Patients Undergoing Atrial Fibrillation Ablation. Cardiovasc Drugs Ther 34, 371–381 (2020). https://doi.org/10.1007/s10557-020-06967-1

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