Skip to main content
SpringerLink
Log in

Bleeding risks with novel oral anticoagulants during catheter ablation of atrial fibrillation: a systematic review and network meta-analysis

  • REVIEWS
  • Published:
Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Background

Comprehensive comparisons of safety (measured by bleeding risk) between multiple novel oral anticoagulants (NOACs and warfarin) in the peri-procedural period of catheter ablation (CA) for atrial fibrillation (AF) are rare.

Methods and results

MEDLINE, EMBASE, and COCHRANE LIBRARY were searched up to February 2015 by two reviewers independently. Predefined inclusion criteria identified 24 studies which were included in the analysis. Data were extracted by two researchers, and a network meta-analysis was conducted in R with R2WinBugS package, within Bayesian framework. Pooled odds ratios (OR) and 95 % confidence intervals (CI) were summarized to evaluate the bleeding risks of three novel anticoagulants (dabigatran, rivaroxaban, apixaban) in AF patients undergoing catheter ablation (CA). With respect to total bleeding risk, no significant difference was observed between dabigatran, rivaroxaban, apixaban, and vitamin K antagonists (VKAs) by mixed-treatment comparison. The similar results were seen in the direct comparison. While dabigatran was associated with a lower rate of minor bleeding in comparison to VKAs (OR = 0.67 with 95 %CI 0.49–0.93).

Conclusions

Risks of bleeding with dabigatran, rivaroxaban, apixaban, and VKAs were similar in peri-procedural period of CA for AF.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Yamaji, H., Murakami, T., Hina, K., Higashiya, S., Kawamura, H., Murakami, M., et al. (2013). Usefulness of dabigatran etexilate as periprocedural anticoagulation therapy for atrial fibrillation ablation. Clinical Drug Investigation, 33(6), 409–418.

    Article  CAS  PubMed  Google Scholar 

  2. Stepanyan, G., Badhwar, N., Lee, R. J., Marcus, G. M., Lee, B. K., Tseng, Z. H., et al. (2014). Safety of new oral anticoagulants for patients undergoing atrial fibrillation ablation. Journal of Interventional Cardiac Electrophysiology, 40(1), 33–38.

    Article  PubMed  Google Scholar 

  3. Dogliotti, A., Paolasso, E., & Giugliano, R. P. (2014). Current and new oral antithrombotics in nonvalvular atrial fibrillation: a network meta-analysis of 79 808 patients. Heart, 100(5), 396–405.

    Article  CAS  PubMed  Google Scholar 

  4. Kaiser, D. W., Streur, M. M., Nagarakanti, R., Whalen, S. P., & Ellis, C. R. (2013). Continuous warfarin versus periprocedural dabigatran to reduce stroke and systemic embolism in patients undergoing catheter ablation for atrial fibrillation or left atrial flutter. Journal of Interventional Cardiac Electrophysiology, 37(3), 241–247.

    Article  PubMed  Google Scholar 

  5. Providencia, R., Marijon, E., Albenque, J. P., Combes, S., Combes, N., Jourda, F., et al. (2014). Rivaroxaban and dabigatran in patients undergoing catheter ablation of atrial fibrillation. Europace, 16(8), 1137–1144.

    Article  PubMed  Google Scholar 

  6. Parikh, V., Agarwal, V., Rijal, J., Chainani, V., Bekheit, S., & Kowalski, M. (2014). The rate of complications associated with concomitant use of dabigatran with cryoballoon ablation for atrial fibrillation. Journal of Atrial Fibrillation, 7(1), 12–15.

    Google Scholar 

  7. Winkle, R. A., Mead, R. H., Engel, G., Kong, M. H., & Patrawala, R. A. (2012). The use of dabigatran immediately after atrial fibrillation ablation. Journal of Cardiovascular Electrophysiology, 23(3), 264–268.

    Article  PubMed  Google Scholar 

  8. Armbruster, H. L., Lindsley, J. P., Moranville, M. P., Habibi, M., Khurram, I. M., Spragg, D. D., et al. (2014). Safety of novel oral anticoagulants compared with uninterrupted warfarin for catheter ablation of atrial fibrillation. Annals of Pharmacotherapy.

  9. Arshad, A., Johnson, C. K., Mittal, S., Buch, E., Hamam, I., Tran, T., et al. (2014). Comparative safety of periablation anticoagulation strategies for atrial fibrillation: data from a large multicenter study. Pacing and Clinical Electrophysiology, 37(6), 665–673.

    Article  PubMed Central  PubMed  Google Scholar 

  10. Bassiouny, M., Saliba, W., Rickard, J., Shao, M., Sey, A., Diab, M., et al. (2013). Use of dabigatran for periprocedural anticoagulation in patients undergoing catheter ablation for atrial fibrillation. Circulation. Arrhythmia and Electrophysiology, 6(3), 460–466.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  11. Dillier, R., Ammar, S., Hessling, G., Kaess, B., Pavaci, H., Buiatti, A., et al. (2014). Safety of continuous periprocedural rivaroxaban for patients undergoing left atrial catheter ablation procedures. Circulation. Arrhythmia and Electrophysiology, 7(4), 576–582.

    Article  CAS  PubMed  Google Scholar 

  12. Eitel, C., Koch, J., Sommer, P., John, S., Kircher, S., Bollmann, A., et al. (2013). Novel oral anticoagulants in a real-world cohort of patients undergoing catheter ablation of atrial fibrillation. Europace, 15(11), 1587–1593.

    Article  PubMed  Google Scholar 

  13. Haines, D. E., Mead-Salley, M., Salazar, M., Marchlinski, F. E., Zado, E., Calkins, H., et al. (2013). Dabigatran versus warfarin anticoagulation before and after catheter ablation for the treatment of atrial fibrillation. Journal of Interventional Cardiac Electrophysiology, 37(3), 233–239.

    Article  PubMed  Google Scholar 

  14. Ichiki, H., Oketani, N., Ishida, S., Iriki, Y., Okui, H., Maenosono, R., et al. (2013). The incidence of asymptomatic cerebral microthromboembolism after atrial fibrillation ablation: comparison of warfarin and dabigatran. Pacing and Clinical Electrophysiology, 36(11), 1328–1335.

    Article  PubMed  Google Scholar 

  15. Imamura, K., Yoshida, A., Takei, A., Fukuzawa, K., Kiuchi, K., Takami, K., et al. (2013). Dabigatran in the peri-procedural period for radiofrequency ablation of atrial fibrillation: efficacy, safety, and impact on duration of hospital stay. Journal of Interventional Cardiac Electrophysiology, 37(3), 223–231.

    Article  PubMed Central  PubMed  Google Scholar 

  16. Kaess, B. M., Ammar, S., Reents, T., Dillier, R., Lennerz, C., Semmler, V., et al. (2015). Comparison of safety of left atrial catheter ablation procedures for atrial arrhythmias under continuous anticoagulation with apixaban versus phenprocoumon. American Journal of Cardiology, 115(1), 47–51.

    Article  PubMed  Google Scholar 

  17. Kaseno, K., Naito, S., Nakamura, K., Sakamoto, T., Sasaki, T., Tsukada, N., et al. (2012). Efficacy and safety of periprocedural dabigatran in patients undergoing catheter ablation of atrial fibrillation. Circulation Journal, 76(10), 2337–2342.

    Article  CAS  PubMed  Google Scholar 

  18. Kim, J. S., She, F., Jongnarangsin, K., Chugh, A., Latchamsetty, R., Ghanbari, H., et al. (2013). Dabigatran vs warfarin for radiofrequency catheter ablation of atrial fibrillation. Heart Rhythm, 10(4), 483–489.

    Article  PubMed  Google Scholar 

  19. Konduru, S. V., Cheema, A. A., Jones, P., Li, Y., Ramza, B., & Wimmer, A. P. (2012). Differences in intraprocedural ACTs with standardized heparin dosing during catheter ablation for atrial fibrillation in patients treated with dabigatran vs. patients on uninterrupted warfarin. Journal of Interventional Cardiac Electrophysiology, 35(3), 277–284. discussion 284.

    Article  PubMed  Google Scholar 

  20. Lakkireddy, D., Reddy, Y. M., Di Biase, L., Vallakati, A., Mansour, M. C., Santangeli, P., et al. (2014). Feasibility and safety of uninterrupted rivaroxaban for periprocedural anticoagulation in patients undergoing radiofrequency ablation for atrial fibrillation: results from a multicenter prospective registry. Journal of the American College of Cardiology, 63(10), 982–988.

    Article  CAS  PubMed  Google Scholar 

  21. Lakkireddy, D., Reddy, Y. M., Di Biase, L., Vanga, S. R., Santangeli, P., Swarup, V., et al. (2012). Feasibility and safety of dabigatran versus warfarin for periprocedural anticoagulation in patients undergoing radiofrequency ablation for atrial fibrillation: results from a multicenter prospective registry. Journal of the American College of Cardiology, 59(13), 1168–1174.

    Article  CAS  PubMed  Google Scholar 

  22. Maddox, W., Kay, G. N., Yamada, T., Osorio, J., Doppalapudi, H., Plumb, V. J., et al. (2013). Dabigatran versus warfarin therapy for uninterrupted oral anticoagulation during atrial fibrillation ablation. Journal of Cardiovascular Electrophysiology, 24(8), 861–865.

    Article  PubMed  Google Scholar 

  23. Nagao, T., Inden, Y., Shimano, M., Fujita, M., Yanagisawa, S., Kato, H., et al. (2014). Efficacy and safety of apixaban in the patients undergoing the ablation of atrial fibrillation. Pacing and Clinical Electrophysiology.

  24. Nin, T., Sairaku, A., Yoshida, Y., Kamiya, H., Tatematsu, Y., Nanasato, M., et al. (2013). A randomized controlled trial of dabigatran versus warfarin for periablation anticoagulation in patients undergoing ablation of atrial fibrillation. PACE - Pacing and Clinical Electrophysiology, 36(2), 172–179.

    Article  PubMed  Google Scholar 

  25. Sairaku, A., Yoshida, Y., Ando, M., Hirayama, H., Nakano, Y., & Kihara, Y. (2013). A head-to-head comparison of periprocedural coagulability under anticoagulation with rivaroxaban versus dabigatran in patients undergoing ablation of atrial fibrillation. Clinical Drug Investigation, 33(11), 847–853.

    Article  CAS  PubMed  Google Scholar 

  26. Snipelisky, D., Kauffman, C., Prussak, K., Johns, G., Venkatachalam, K., & Kusumoto, F. (2012). A comparison of bleeding complications post-ablation between warfarin and dabigatran. Journal of Interventional Cardiac Electrophysiology, 35(1), 29–33.

    Article  PubMed  Google Scholar 

  27. Winkle, R. A., Mead, R. H., Engel, G., Kong, M. H., & Patrawala, R. A. (2014). Peri-procedural interrupted oral anticoagulation for atrial fibrillation ablation: comparison of aspirin, warfarin, dabigatran, and rivaroxaban. Europace, 16(10), 1443–1449.

    Article  PubMed Central  PubMed  Google Scholar 

  28. Chaimani, A., Higgins, J. P., Mavridis, D., Spyridonos, P., & Salanti, G. (2013). Graphical tools for network meta-analysis in STATA. PLoS One, 8(10), e76654.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  29. Hohnloser, S. H., & Camm, A. J. (2013). Safety and efficacy of dabigatran etexilate during catheter ablation of atrial fibrillation: a meta-analysis of the literature. Europace, 15(10), 1407–1411.

    Article  PubMed  Google Scholar 

  30. Providencia, R., Albenque, J. P., Combes, S., Bouzeman, A., Casteigt, B., Combes, N., et al. (2014). Safety and efficacy of dabigatran versus warfarin in patients undergoing catheter ablation of atrial fibrillation: a systematic review and meta-analysis. Heart, 100(4), 324–335.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  31. Sardar, P., Nairooz, R., Chatterjee, S., Wetterslev, J., Ghosh, J., & Aronow, W. S. (2014). Meta-analysis of risk of stroke or transient ischemic attack with dabigatran for atrial fibrillation ablation. American Journal of Cardiology, 113(7), 1173–1177.

    Article  CAS  PubMed  Google Scholar 

  32. Shurrab, M., Morillo, C. A., Schulman, S., Kansal, N., Danon, A., Newman, D., et al. (2013). Safety and efficacy of dabigatran compared with warfarin for patients undergoing radiofrequency catheter ablation of atrial fibrillation: a meta-analysis. Canadian Journal of Cardiology, 29(10), 1203–1210.

    Article  PubMed  Google Scholar 

  33. Steinberg, B. A., Hasselblad, V., Atwater, B. D., Bahnson, T. D., Washam, J. B., Alexander, J. H., et al. (2013). Dabigatran for periprocedural anticoagulation following radiofrequency ablation for atrial fibrillation: a meta-analysis of observational studies. Journal of Interventional Cardiac Electrophysiology, 37(3), 213–221.

    Article  PubMed  Google Scholar 

  34. Aryal, M. R., Ukaigwe, A., Pandit, A., Karmacharya, P., Pradhan, R., Mainali, N. R., et al. (2014). Meta-analysis of efficacy and safety of rivaroxaban compared with warfarin or dabigatran in patients undergoing catheter ablation for atrial fibrillation. American Journal of Cardiology, 114(4), 577–582.

    Article  CAS  PubMed  Google Scholar 

  35. Schulman, S. (2014). Advantages and limitations of the new anticoagulants. Journal of Internal Medicine, 275(1), 1–11.

    Article  CAS  PubMed  Google Scholar 

Download references

Conflict of interest

The authors declare that they have no competing interests.

Author information

Authors and Affiliations

  1. Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300# Guangzhou road, Nanjing, 210029, Jiangsu Province, China

    Dasheng Lu, Qi Zhang, Qian Liu, Kai Wang, Shengchan Wang & Qijun Shan

Authors
  1. Dasheng Lu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Qi Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Qian Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kai Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Shengchan Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Qijun Shan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Qijun Shan.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lu, D., Zhang, Q., Liu, Q. et al. Bleeding risks with novel oral anticoagulants during catheter ablation of atrial fibrillation: a systematic review and network meta-analysis. J Interv Card Electrophysiol 44, 105–111 (2015). https://doi.org/10.1007/s10840-015-0053-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10840-015-0053-x

Keywords

Search

Navigation