Thromboembolism and bleeding risk in atrial fibrillation ablation with uninterrupted anticoagulation between new oral anticoagulants and vitamin K antagonists: insights from an updated meta-analysis

  • Xiao-Hua Liu
  • Xiao-Fei Gao
  • Chao-Feng Chen
  • Bin Chen
  • Yi-Zhou XuEmail author


Cumulative reports comparing the efficacy and safety outcomes between uninterrupted NOACs and vitamin K antagonists (VKA) in AF ablation had been freshly published. This meta-analysis aimed at offering a more comprehensive evaluation between these two anticoagulants in uninterrupted strategy. We searched in PUBMED, EMBASE, and Cochrane Library (inception to June 10, 2019) for eligible studies. Fixed-effects model was preferred in pooled analysis if I2 < 50%. Publication bias was also evaluated. A total of 23 studies involving 12,725 individuals were analyzed in this literature. There were no difference between uninterrupted NOACs and VKA groups in incidence of Stroke/TIA (RR 0.98, 95% CI 0.54–1.77, P = 0.93, I2 = 0%), silent cerebral embolism (RR 1.09, 95% CI 0.82–1.43, P = 0.56, I2 = 0%), minor bleeding complication (RR 0.97, 95% CI 0.83–1.14, P = 0.73, I2 = 0%), cardiac tamponade (RR 0.95, 95% CI 0.63–1.42, P = 0.80, I2 = 0%). Uninterrupted NOACs was associated with significantly lower major bleeding incidence (RR 0.67, 95% CI 0.49–0.92, P = 0.01, I2 = 0%), pericardial effusion (RR 0.75, 95% CI 0.56–1.00, P = 0.048, I2 = 9%). In sub-analysis, no difference was found in all sub-analyses for Stroke/TIA while significant major bleeding risk reduction in uninterrupted NOACs was identified in the subgroup of CHA2DS2-VASc score ≥ 2 and target activated clotting time (ACT) > 300 s. In conclusions, uninterrupted NOACs was more effective than uninterrupted VKA in reducing major bleeding and pericardial effusion risk without increasing thromboembolism risk, and the benefits of uninterrupted NOACs on major bleeding complication could be more pronounced if CHA2DS2-VASc score ≥ 2 or target ACT > 300 s.


Uninterrupted NOACs VKA Catheter ablation Atrial fibrillation 



We would appreciate the kind help from Mr. Jin and Xiao Bai for photo editing.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

Informed consent was obtained from all participants included in the study.

Supplementary material

11239_2019_1989_MOESM1_ESM.pdf (806 kb)
Supplementary material 1 (PDF 806.0 kb)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Xiao-Hua Liu
    • 1
  • Xiao-Fei Gao
    • 1
  • Chao-Feng Chen
    • 1
  • Bin Chen
    • 1
  • Yi-Zhou Xu
    • 1
    Email author
  1. 1.Department of Cardiology, Affiliated Hangzhou First People’s HospitalZhejiang University School of MedicineHangzhouChina

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