Uninterrupted New Oral Anticoagulants Compared With Uninterrupted Vitamin K Antagonists in Ablation of Atrial Fibrillation: A Meta-analysis

Nairooz, Ramez; Ayoub, Karam; Sardar, Partha; Payne, Jason; Almomani, Ahmed; Pothineni, Naga Venkata K.; Shailesh, Fnu; Aronow, Wilbert S.; Mukherjee, Debabrata

doi:10.1016/j.cjca.2015.09.012

Cited by 24 publications

(15 citation statements)

References 31 publications

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“…The timing and dosing of bridging anticoagulation (ie, pre‐operative, peri‐operative or postoperative only) are also unknown 35. Third, we excluded studies that exclusively evaluated cardiac ablation, as this topic has been extensively studied36, 37 This may have biased our results towards lower bleeding rates, as cardiac ablation procedures possibly carry a lower postoperative bleeding risk as compared to major procedures. We also excluded studies that focussed exclusively on emergent procedures.…”

Section: Discussionmentioning

confidence: 99%

Perioperative interruption of direct oral anticoagulants in patients with atrial fibrillation: A systematic review and meta‐analysis

Shaw

Woodfine

Douketis

et al. 2018

Research and Practice in Thrombosis and Haemostasis

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Essentials Little evidence exists to guide procedural interruption of direct oral anticoagulants (DOACs).Conducted a meta‐analysis of the interruption of DOACs in patients with atrial fibrillation (AF).The 30‐day risk for thromboembolic and major bleeding events were 0.4% and 1.8%, respectively.Perioperative interruption of DOACs in patients with AF appears to be safe and effective. BackgroundPatients with atrial fibrillation (AF) frequently undergo invasive procedures that require temporary interruption of anticoagulation. There is little evidence to guide the perioperative interruption of direct oral anticoagulants (DOACs).MethodsA systematic literature search including studies that evaluated the perioperative interruption of DOACs for non‐emergent invasive procedures in patients with AF was performed. The primary outcomes of interest were the 30‐day risk of thromboembolic events and major bleeding. Secondary outcomes of interest included the 30‐day risk of minor bleeding and overall mortality. The systematic review protocol and search strategy were registered online (PROSPERO January 27th 2017:CRD42017056124).ResultsA total of 8 publications encompassing 14 446 patients and 17 107 periprocedural interruptions were included in our study. Our analysis revealed a pooled postoperative 30‐day thromboembolic complication risk of 0.41% (95% CI 0.29‐ 0.54), and a pooled 30‐day postoperative major bleeding risk of 1.81% (95% CI 0.84‐3.13). Pooled 30‐day postoperative risks of minor bleeding and overall mortality were 3.08% (95% CI 1.02‐6.20) and 0.67% (95% CI 0.29‐1.23), respectively. Meta‐analysis of the included comparative studies did not reveal any significant differences in these postoperative outcomes following the perioperative interruption of DOACs or vitamin K antagonists.ConclusionsThe perioperative interruption of DOACs in patients with AF was associated with 0.4% thromboembolic and 1.8% major bleeding events at 30 days post surgery. These findings seem reassuring, but require validation in large prospective management studies where pre‐operative DOAC levels are measured and compared with clinical outcomes in this patient population.

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Section: Discussionmentioning

confidence: 99%

Perioperative interruption of direct oral anticoagulants in patients with atrial fibrillation: A systematic review and meta‐analysis

Shaw

Woodfine

Douketis

et al. 2018

Research and Practice in Thrombosis and Haemostasis

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“…[298][299][300][301] Two recent systematic reviews with meta-analyses that include studies with such patients consistent with results. 302,303 Long-term Anticoagulation After Restoration of Sinus Rhythm…”

Section: Catheter or Surgical Ablation Electrophysiological Proceduresmentioning

confidence: 99%

Antithrombotic Therapy for Atrial Fibrillation

Lip

Banerjee

Boriani

et al. 2018

Chest

754

328

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“…7,8 A previous meta-analysis showed no difference in bleeding or thromboembolic events between uninterrupted NOACs and VKAs in patients undergoing AF ablation. 9 However, because of relatively small sample sizes in individual studies and rare outcomes, these results may have been underpowered. More recently, numerous studies were published, including additional randomized data that may strengthen the power of pooled outcomes.…”

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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Uninterrupted New Oral Anticoagulants Compared With Uninterrupted Vitamin K Antagonists in Ablation of Atrial Fibrillation: A Meta-analysis

Cited by 24 publications

References 31 publications

Perioperative interruption of direct oral anticoagulants in patients with atrial fibrillation: A systematic review and meta‐analysis

Perioperative interruption of direct oral anticoagulants in patients with atrial fibrillation: A systematic review and meta‐analysis

Antithrombotic Therapy for Atrial Fibrillation

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

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