Benefits and Risks Associated with Long-term Oral Anticoagulation after Successful Atrial Fibrillation Catheter Ablation: Systematic Review and Meta-analysis

Maduray, Kellina; Moneruzzaman, Md.; Changwe, Geoffrey Joseph; Zhong, Jingquan

doi:10.1177/10760296221118480

Cited by 6 publications

(1 citation statement)

References 64 publications

(277 reference statements)

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“… 169 A more recent meta-analysis including 20 studies with 22 429 patients (13 505 off-OAC) stratified CHA 2 DS 2 -VASc score ≥2 examining thrombo-embolic events, also favoured OAC continuation (OR 1.86; 95% CI: 1.02–3.40; P = 0.04). 175 …”

Section: Better Symptom Managementmentioning

confidence: 99%

Atrial fibrillation and stroke prevention: 25 years of research at EP Europace journal

Lip,

Proietti,

Potpara

et al. 2023

Europace

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Stroke prevention in patients with atrial fibrillation (AF) is one pillar of the management of this common arrhythmia. Substantial advances in the epidemiology and associated pathophysiology underlying AF-related stroke and thrombo-embolism are evident. Furthermore, the introduction of the non-vitamin K antagonist oral anticoagulants (also called direct oral anticoagulants) has clearly changed our approach to stroke prevention in AF, such that the default should be to offer oral anticoagulation for stroke prevention, unless the patient is at low risk. A strategy of early rhythm control is also beneficial in reducing strokes in selected patients with recent onset AF, when compared to rate control. Cardiovascular risk factor management, with optimization of comorbidities and attention to lifestyle factors, and the patient’s psychological morbidity are also essential. Finally, in selected patients with absolute contraindications to long-term oral anticoagulation, left atrial appendage occlusion or exclusion may be considered. The aim of this state-of-the-art review article is to provide an overview of the current status of AF-related stroke and prevention strategies. A holistic or integrated care approach to AF management is recommended to minimize the risk of stroke in patients with AF, based on the evidence-based Atrial fibrillation Better Care (ABC) pathway, as follows: A: Avoid stroke with Anticoagulation; B: Better patient-centred, symptom-directed decisions on rate or rhythm control; C: Cardiovascular risk factor and comorbidity optimization, including lifestyle changes.

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Section: Better Symptom Managementmentioning

confidence: 99%

Atrial fibrillation and stroke prevention: 25 years of research at EP Europace journal

Lip,

Proietti,

Potpara

et al. 2023

Europace

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Prevention of cerebral thromboembolism by oral anticoagulation with dabigatran after pulmonary vein isolation for atrial fibrillation: the ODIn-AF trial

Schrickel,

Beiert,

Linhart

et al. 2023

Clin Res Cardiol

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Background and objectives Long-term oral anticoagulation (OAC) following successful catheter ablation of atrial fibrillation (AF) remains controversial. Prospective data are missing. The ODIn-AF study aimed to evaluate the effect of OAC on the incidence of silent cerebral embolic events and clinically relevant cardioembolic events in patients at intermediate to high risk for embolic events, free from AF after pulmonary vein isolation (PVI). Methods This prospective, randomized, multicenter, open-label, blinded endpoint interventional trial enrolled patients who were scheduled for PVI to treat paroxysmal or persistent AF. Six months after PVI, AF-free patients were randomized to receive either continued OAC with dabigatran or no OAC. The primary endpoint was the incidence of new silent micro- and macro-embolic lesions detected on brain MRI at 12 months of follow-up compared to baseline. Safety analysis included bleedings, clinically evident cardioembolic, and serious adverse events (SAE). Results Between 2015 and 2021, 200 patients were randomized into 2 study arms (on OAC: n = 99, off OAC: n = 101). There was no significant difference in the occurrence of new cerebral microlesions between the on OAC and off OAC arm [2 (2%) versus 0 (0%); P = 0.1517] after 12 months. MRI showed no new macro-embolic lesion, no clinical apparent strokes were present in both groups. SAE were more frequent in the OAC arm [on OAC n = 34 (31.8%), off OAC n = 18 (19.4%); P = 0.0460]; bleedings did not differ. Conclusion Discontinuation of OAC after successful PVI was not found to be associated with an elevated risk of cerebral embolic events compared with continued OAC after a follow-up of 12 months. Graphical abstract

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Novel stroke prevention strategies following catheter ablation for atrial fibrillation

Ding,

Calvert,

Lip

et al. 2024

Revista Española de Cardiología (English Edition)

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Benefits and Risks Associated with Long-term Oral Anticoagulation after Successful Atrial Fibrillation Catheter Ablation: Systematic Review and Meta-analysis

Cited by 6 publications

References 64 publications

Atrial fibrillation and stroke prevention: 25 years of research at EP Europace journal

Atrial fibrillation and stroke prevention: 25 years of research at EP Europace journal

Prevention of cerebral thromboembolism by oral anticoagulation with dabigatran after pulmonary vein isolation for atrial fibrillation: the ODIn-AF trial

Novel stroke prevention strategies following catheter ablation for atrial fibrillation

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