Evaluation of safety and efficacy of periprocedural use of rivaroxaban and apixaban in catheter ablation for atrial fibrillation

Yoshimura, Akihiro; Iriki, Yasuhisa; Ichiki, Hitoshi; Oketani, Naoya; Okui, Hideki; Maenosono, Ryuichi; Namino, Fuminori; Miyata, Masaaki; Ohishi, Mitsuru

doi:10.1016/j.jjcc.2016.03.014

Cited by 25 publications

(24 citation statements)

References 54 publications

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“…The process of the systematic literature search, screening, and selection is described in the PRISMA flow chart (Figure 1); 1757 records were identified by primary searches using pre‐specified keywords, and 984 duplicate records were removed. After excluding 749 records based on the abstract/title and another 15 records after detailed article screening, six RCTs 20‐25 and three POSs 26‐28 published between 2016 and 2019 were included in the meta‐analyses. The nine studies included 2578 patients, and 55% (1410/2578) of these patients received MI‐NOAC with up to two doses withheld before AF ablation.…”

Section: Resultsmentioning

confidence: 99%

Peri‐procedural novel oral anticoagulants dosing strategy during atrial fibrillation ablation: A meta‐analysis

Mao

Wang

Huang

2020

Pacing Clinical Electrophis

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BACKGROUND: Studies indicate that uninterrupted anticoagulation is superior to interrupted anticoagulation in the periprocedural period during catheter ablation of atrial brillation and has better thromboembolic and hemorrhagic outcomes. Conversely, the few studies addressing the safety and e cacy of interrupted direct oral anticoagulant regimens during catheter ablation of atrial brillation are limited by small samples, short follow-up periods, rare events, and variable outcomes. The purpose of this metaanalysis was to compare interrupted and uninterrupted direct oral anticoagulation during catheter ablation of atrial brillation. METHODS: A systematic search into PubMed, EMBASE, and the Cochrane databases were performed and ve studies were selected that directly that directly compared interrupted versus uninterrupted anticoagulation before ablation and reported procedural outcomes and embolic and bleeding events. The primary outcome of the study was major adverse cerebrocardiovascular events which was a composite of stroke/ transient ischemic attacks and major bleedings, total bleeding which was a composite of major and minor bleedings and silent cerebral events. RESULTS The meta-analysis included 840 patients with uninterrupted anticoagulation and 938 patients with interrupted anticoagulation. Median follow-up was 30 days. Baseline parameters were similar between groups. Activated clotting time before rst heparin bolus was signi cantly longer with uninterrupted anticoagulation (P=.006), whereas mean activated clotting time was similar between the 2 groups (P=.19). Total heparin dose needed was signi cantly higher with interrupted anticoagulation (mean,-1.61; 95% CI,-2.67 to-0.55; P=.003). Mean procedure time did not vary between groups (P=.81). Overall complication rates were low, with similar major adverse cerebrocardiovascular event (P=.40) and total bleeding (P=.55) rates between groups. Silent cerebral events were signi cantly more frequent with interrupted anticoagulation (log odds ratio,-0.90; 95% CI,-1.59 to-0.22; P<.01; I 2 , 33%). Rates of major bleeding, minor bleeding, pericardial effusion, cardiac tamponade, and puncture complications were similar between groups. CONCLUSIONS Uninterrupted anticoagulation during atrial brillation ablation has similar bleeding event rates, procedural times, and mean activated clotting times as interrupted anticoagulation, with fewer silent cerebral events.

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Section: Resultsmentioning

confidence: 99%

Peri‐procedural novel oral anticoagulants dosing strategy during atrial fibrillation ablation: A meta‐analysis

Mao

Wang

Huang

2020

Pacing Clinical Electrophis

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“…Of these, 42 were excluded as they did not meet the inclusion criteria (7 reviews and meta-analysis; 7 papers without outcomes of OACs; 9 papers without separate information on apixaban or rivaroxaban or dabigatran or edoxaban; 12 studies with duplicate data, 1 on the setting of direct current cardioversion and 7 with mixed diseases except for AF). Finally, 30 studies were included, 11 of which were studies on specific settings of RFA 9,[11][12][13][14][15][16][17][18][19][20] . The selection process is shown in…”

Section: Resultsmentioning

confidence: 99%

Meta-Analysis of Effectiveness and Safety of Oral Anticoagulants in Atrial Fibrillation With Focus on Apixaban

Bai

Xubo

et al. 2017

The American Journal of Cardiology

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We performed a meta-analysis of data on the effectiveness and safety of apixaban compared with other oral anticoagulants (warfarin or rivaroxaban or dabigatran or edoxaban) for stroke prevention in atrial fibrillation (AF) in different settings of randomized controlled trials, real-world studies, and radiofrequency ablation (RFA). Thirty studies were searched in PubMed, the Cochrane Library, and Clinicaltrials.gov databases reporting comparative effectiveness and safety of apixaban with warfarin (n = 23), rivaroxaban (n = 12), dabigatran (n = 13), or edoxaban (n = 2) for stroke prevention in AF. In real-world estimates, apixaban was similar to warfarin for the prevention of stroke or systematic thromboembolism (hazard ratio 0.93, 95% CI 0.71 to 1.14, I = 82.9%, N = 7), and safer than warfarin in the risks of major bleeding (hazard ratio 0.62, 95% CI 0.54 to 0.70, I = 18.7%, N = 9) in patients with AF. The risk of stroke or thromboembolism with apixaban was similar to rivaroxaban, dabigatran, and edoxaban in the settings of real-world studies and RFA. Major bleeding with apixaban was generally lower than rivaroxaban (relative risks 0.45, 95% CI 0.38 to 0.53, I = 0%, N = 5) and similar to dabigatran in real-world studies (relative risks 1.44, 95% CI 0.33 to 6.30, I = 97.7%, N = 5), but similar to rivaroxaban, dabigatran, and edoxaban in RFA. In conclusion, our meta-analysis provides a comprehensive estimate of the effectiveness and safety of apixaban compared with other oral anticoagulants (warfarin, rivaroxaban, dabigatran, and edoxaban) in patients with AF in different settings of randomized controlled trial, real-world studies, and RFA.

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“…Dillier et al 18 used phenprocoumon as VKA, whereas warfarin was used in all other studies. The target international normalized ratio (INR) in the VKA group was 2.0-3.0 in all studies, except for patients in Yoshimura et al 13 (target INR not reported) and patients aged 70 years and older in Nagao et al 22 (target INR 1.6-2.6).…”

Section: Study Selection and Characteristicsmentioning

confidence: 90%

“…More recently, numerous studies were published, including additional randomized data that may strengthen the power of pooled outcomes. [10][11][12][13] Therefore, we aimed to perform an updated systematic review and meta-analysis to investigate the efficacy and safety of NOACs vs VKAs for uninterrupted OAC in patients with AF undergoing catheter ablation.…”

Section: Introductionmentioning

confidence: 99%

An updated meta-analysis of novel oral anticoagulants versus vitamin K antagonists for uninterrupted anticoagulation in atrial fibrillation catheter ablation

et al. 2018

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Evaluation of safety and efficacy of periprocedural use of rivaroxaban and apixaban in catheter ablation for atrial fibrillation

Abstract: The incidence of asymptomatic cerebral microthromboembolism and hemopericardium in AF ablation is similar among the periprocedural use of rivaroxaban, apixaban, and warfarin.

Cited by 25 publications

References 54 publications

Peri‐procedural novel oral anticoagulants dosing strategy during atrial fibrillation ablation: A meta‐analysis

Peri‐procedural novel oral anticoagulants dosing strategy during atrial fibrillation ablation: A meta‐analysis

Meta-Analysis of Effectiveness and Safety of Oral Anticoagulants in Atrial Fibrillation With Focus on Apixaban

An updated meta-analysis of novel oral anticoagulants versus vitamin K antagonists for uninterrupted anticoagulation in atrial fibrillation catheter ablation

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