Safety and efficacy of dabigatran versus warfarin in patients undergoing catheter ablation of atrial fibrillation: a systematic review and meta-analysis

Abstract

BackgroundDabigatran etexilate, a new thrombin inhibitor, has been shown to be comparable to warfarin in patients with atrial fibrillation (AF). However, there is a limited body of evidence on the efficacy and safety of using dabigatran among patients undergoing AF catheter ablation.ObjectiveA random effects meta-analysis was performed of controlled trials comparing dabigatran and warfarin in paroxysmal/persistent AF patients undergoing catheter ablation.MethodsData sources included Medline, Embase, and Cochrane (from inception to April 2013). Three independent reviewers selected studies comparing warfarin to dabigatran. Descriptive and quantitative information was extracted from each selected study, regarding periprocedural all cause mortality, thromboembolic events and major bleeding, as well as modalities of periprocedural anticoagulation bridging.ResultsAfter a detailed screening of 228 search results, 14 studies were identified enrolling a total of 4782 patients (1823 treated with dabigatran and 2959 with warfarin). No deaths were reported. No significant differences were found between patients treated with dabigatran and warfarin as regards thromboembolic events (0.55% dabigatran vs 0.17% warfarin; risk ratios (RR)=1.78, 95% CI 0.66 to 4.80; p=0.26) and major bleeding (1.48% dabigatran vs 1.35% warfarin; RR=1.07, 95% CI 0.51 to 2.26; p=0.86). No difference was found between the 110 mg twice daily and 150 mg twice daily dabigatran dosages concerning major bleeding (0% vs 1.62%, respectively; RR=0.19, 95% CI 0.01 to 3.18; p=0.25) and thromboembolism (0% vs 0.40%, respectively; RR=0.72, 95% CI 0.04 to 12.98; p=0.82).ConclusionsIn the specific setting of AF catheter ablation, this first pooled analysis suggests that patients treated with dabigatran have a similar incidence of thromboembolic events and major bleeding compared to warfarin, with low event rates overall.

Almanac 2015: atrial fibrillation research in Heart

“…73 There was no significant difference found between the two groups for either of the two end points. However, a numerical difference of more thromboembolic events in dabigatran group versus warfarin (0.55% dabigatran vs 0.17% warfarin, RR 1.78, 95% CI 0.66 to 4.80, p=0.26) was seen.…”

Possibility of Novel Oral Anticoagulants Usage During Ablation in Atrial Fibrillation

“…Недавно это заключение было подтверждено результатами проведенного мета-анализа [25]. Другой наиболее крупный мета-анализ 10 исследований, которые были представлены за последние три года, опубликован в журнале Europace в 2013г [26].…”

Periprocedural Management of New Oral Anticoagulants in Patients Undergoing Atrial Fibrillation Ablation

“…Based on the results of these studies, which are summarized in Table 3, the risks of thromboembolic and bleeding complications with minimally interrupted dabigatran appear to be similar to those with uninterrupted warfarin; a conclusion supported by a recent meta-analysis. 16 Although there is less information about the efficacy and safety of other NOACs in patients undergoing ablation, data are emerging. Thus, in a multicenter prospective study, uninterrupted rivaroxaban was compared with uninterrupted warfarin in 157 patients undergoing AF ablation.…”