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Lower Major Bleeding Rates with Direct Oral Anticoagulants in Catheter Ablation of Atrial Fibrillation: an Updated Meta-analysis of Randomized Controlled Studies

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Abstract

Introduction

Catheter ablation (CA) of atrial fibrillation (AF) is an important rhythm control strategy for patients with drug-refractory AF. We aimed to perform an updated meta-analysis of direct oral anticoagulants (DOACs) vs vitamin K antagonists (VKAs) as uninterrupted anticoagulation in patients undergoing AF ablation to assess safety and efficacy of DOAC, after the publication of recent data on edoxaban in CA of AF.

Methods

We performed a meta-analysis of RCTs enrolling patients undergoing AF ablation. We assessed Mantel-Haenszel pooled estimates of risk ratios (RRs) and 95% CIs for thromboembolic events, major bleeding (MB), and non-major bleeding (NMB).

Results

A total of 2118 patients have been included in the analysis. Compared with patients receiving VKA, patients receiving DOACs had a lower, although non-significant, risk of thromboembolic events (RR, 0.40; 95% CI, 0.09–1.76; P = 0.23). MB rates in patients treated with DOACs were statistically significantly lower than VKA (RR, 0.61; 95% CI, 0.39–0.93, P = 0.02). The incidence of NMB was not significantly different (RR, 0.98; 95% CI, 0.83–1.57, p n.s.).

Conclusions

In a meta-analysis of RCTs, an uninterrupted DOACs strategy for CA of AF appears to be superior to uninterrupted VKA in terms of safety; a non-significant trend favoring DOACs in terms of efficacy is also evident.

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References

  1. Chugh SS, Havmoeller R, Narayanan K, Singh D, Rienstra M, Benjamin EJ, et al. Worldwide epidemiology of atrial fibrillation: a global burden of disease 2010 study. Circulation. 2014;129:837–47.

    Article  Google Scholar 

  2. Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. Stroke. 1991;22:983–8.

    Article  CAS  Google Scholar 

  3. Knight BP. Anticoagulation for atrial fibrillation ablation – what is the optimal strategy? J Am Coll Cardiol. 2012;59:1175–7.

    Article  Google Scholar 

  4. Heeger CH, Rillig A, Geisler D, Wohlmuth P, Fink T, Mathew S, et al. Left atrial appendage isolation in patients not responding to pulmonary vein isolation. Circulation. 2019;139(5):712–5.

    Article  Google Scholar 

  5. Cappato R, Calkins H, Chen SA, Davies W, Iesaka Y, Kalman J, et al. Updated worldwide survey on the methods, efficacy, and safety of catheter ablation for human atrial fibrillation. Circ Arrhythm Electrophysiol. 2010;3:32–8.

    Article  Google Scholar 

  6. Calkins H, Hindricks G, Cappato R, Kim YH, Saad EB, Aguinaga L, et al. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Heart Rhythm. 2017;14:e275–444.

    Article  Google Scholar 

  7. Cappato R, Marchlinski FE, Hohnloser SH, Naccarelli GV, Xiang J, Wilber DJ, et al. VENTURE-AF Investigators Uninterrupted rivaroxaban vs uninterrupted vitamin K antagonists for catheter ablation in non-valvular atrial fibrillation. Eur Heart J. 2015;36:1805–11.

    Article  CAS  Google Scholar 

  8. Hohnloser SH, Camm J, Cappato R, Diener HC, Heidbüchel H, Mont L, et al. Uninterrupted edoxaban vs. vitamin K antagonists for ablation of atrial fibrillation: the ELIMINATE-AF trial. Eur Heart J. 2019:ehz190.

  9. Calkins H, Willems S, Gerstenfeld EP, Verma A, Schilling R, Hohnloser SH, et al. Grimaldi M; RE-CIRCUIT investigators. Uninterrupted Dabigatran versus warfarin for ablation in atrial fibrillation. N Engl J Med. 2017;376(17):1627–36.

    Article  CAS  Google Scholar 

  10. Kirchhof P, Haeusler KG, Blank B, De Bono J, Callans D, Elvan A, et al. Apixaban in patients at risk of stroke undergoing atrial fibrillation ablation. Eur Heart J. 2018;39:2942–55.

    Article  CAS  Google Scholar 

  11. Weitz JI, Healey JS, Skanes AC, Verma A. Periprocedural management of new oral anticoagulants in patients undergoing atrial fibrillation ablation. Circulation. 2014;129:1688–94.

    Article  Google Scholar 

  12. Romero J, Cerrud-Rodriguez RC, Diaz JC, Michaud GF, Taveras J, Alviz I, et al. Uninterrupted direct oral anticoagulants vs. uninterrupted vitamin K antagonists during catheter ablation of non-valvular atrial fibrillation: a systematic review and meta-analysis of randomized controlled trials. Europace. 2018;20(10):1612–20.

    Article  Google Scholar 

  13. Calkins H, Hindricks G, Cappato R, Kim YH, Saad EB, Aguinaga L, et al. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Europace. 2018;20:e1–e160.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Medical & Surgical Sciences, University of Foggia, Foggia, Italy

    Natale Daniele Brunetti, Lucia Tricarico, Michele Correale & Francesco Santoro

  2. Division of Electrophysiology, Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Heart Center Luebeck, Luebeck, Germany

    Roland R. Tilz & Christian-H Heeger

  3. Cardiology Department, Ospedale San Paolo, Bari, Italy

    Luisa De Gennaro

  4. Cardiology Department, Ospedali Riuniti University Hospital, Foggia, Italy

    Riccardo Ieva

  5. GVM Care & Research, Santa Maria Hospital, Bari, Italy

    Matteo Di Biase

  6. Department of Cardiology-Electrophysiology, University Heart Center, University of Hamburg, Hamburg, Germany

    Andreas Rillig & Andreas Metzner

Authors
  1. Natale Daniele Brunetti
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  2. Lucia Tricarico
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  3. Roland R. Tilz
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  4. Christian-H Heeger
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  5. Luisa De Gennaro
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  6. Michele Correale
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  7. Riccardo Ieva
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  8. Matteo Di Biase
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  9. Andreas Rillig
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  10. Andreas Metzner
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  11. Francesco Santoro
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Correspondence to Natale Daniele Brunetti.

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Conflict of Interest

AR received speaker honoraria from Boehringer Ingelheim. No other conflict of interest to disclose.

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Brunetti, N.D., Tricarico, L., Tilz, R.R. et al. Lower Major Bleeding Rates with Direct Oral Anticoagulants in Catheter Ablation of Atrial Fibrillation: an Updated Meta-analysis of Randomized Controlled Studies. Cardiovasc Drugs Ther 34, 209–214 (2020). https://doi.org/10.1007/s10557-020-06947-5

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  • DOI: https://doi.org/10.1007/s10557-020-06947-5

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