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Network meta-analysis of efficacy and safety of competitive oral anticoagulants in patients undergoing radiofrequency catheter ablation of atrial fibrillation

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Abstract

Purpose

The aim of this network meta-analysis was to evaluate the comparative efficacy and safety of dabigatran, rivaroxaban, apixaban, interrupted vitamin K antagonist (I-VKA), and continuous VKA (C-VKA) in patients undergoing radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF).

Methods

PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials were searched to identify clinical trials comparing dabigatran, rivaroxaban, or apixaban with I-VKA or C-VKA, or against each other, in AF patients undergoing RFCA. A network meta-analysis was conducted to directly and indirectly compare the efficacy and safety of competitive anticoagulation regimens with a Bayesian random-effects model.

Results

A total of 39 studies enrolling 27,766 patients were included. C-VKA demonstrated significant superiority over I-VKA in reducing thromboembolic events (risk difference [RD] −0.0068, 95 % confidence interval [CI] −0.0106 to −0.0032) and major bleeding complications (RD −0.0044, 95 % CI −0.0098 to −0.0006). Rivaroxaban compared with I-VKA was associated with a lower risk of thromboembolism (RD −0.0073, 95 % CI −0.0134 to −0.0012), being at the best ranking position among all of the compared anticoagulation regimens in terms of both the efficacy and safety. None of the remaining comparisons reached statistically significant difference in the rate of thromboembolism or major bleeding.

Conclusions

The present study suggests that C-VKA is superior to I-VKA for AF patients undergoing RFCA. Rivaroxaban is the highest probability to be the optimal alternative to C-VKA among the three non-VKA oral anticoagulants in AF ablation.

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Acknowledgments

We thank Professor Dong-Tao Lin (College of Foreign Languages, Sichuan University) for providing language help.

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Authors and Affiliations

  1. Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, 37 Guoxue Road, Chengdu, Sichuan, People’s Republic of China, 610041

    Pei-Jun Li, Ting Wang & Zong-An Liang

  2. Department of Intensive Care Unit, West China Hospital, Sichuan University, 37 Guoxue Road, Chengdu, 610041, People’s Republic of China

    Jun Xiao

  3. Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Road, Chengdu, 610041, People’s Republic of China

    Qing Yang & Yuan Feng

  4. Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, 37 Guoxue Road, Chengdu, 610041, People’s Republic of China

    Guan-Jian Liu

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Li, PJ., Xiao, J., Yang, Q. et al. Network meta-analysis of efficacy and safety of competitive oral anticoagulants in patients undergoing radiofrequency catheter ablation of atrial fibrillation. J Interv Card Electrophysiol 46, 213–224 (2016). https://doi.org/10.1007/s10840-016-0126-5

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