Abstract 16938: Novel Oral Anticoagulants (NOAC) vs Warfarin Peri-Ablation for Atrial Fibrillation (AF): A Meta-Analysis of Embolic and Bleeding Complications
Introduction: NOAC like dabigatran and rivaroxaban (R) are being used pre and post AF ablation. There are concerns that peri-AF ablation use of NOAC may be associated with worse outcome than warfarin (W). However, individual studies may be too small to accurately compare anticoagulation strategies given low procedural complication rates.
Methods: We conducted a meta-analysis of all published abstracts (n=10) and papers (n=10) to date that compared complication rates for peri-AF ablation use of NOAC vs W (with or without heparin bridging). Bleeding complications included pericardial effusion, groin hematoma, GI bleeding and embolic complications included any systemic embolism. We used the Mantel-Haenszel fixed effect model for pooling the study results, with a random effects model for heterogeneous samples/results.
Results: The 2614 pts on a NOAC (9.6% R) were similar to the 4262 pts on W. NOAC were stopped 2.5-96 hrs pre-procedure and restarted 1-48 hrs post-procedure; in 3190 (75%) W pts, W was uninterrupted. Composite bleeding rates were significantly lower in NOAC pts (4.47% vs 6.96% in W, OR 0.60, 95% CI 0.48-0.75; I2 = 47%). Composite embolic rates were similar in both groups (0.61% in NOAC vs 0.39% in W, OR 1.42, 95% CI 0.76-2.66; I2 = 0%; Figure)
Conclusions: This meta-analysis demonstrates that NOAC are an alternative for per-AF ablation anticoagulation. They are associated with a decrease in bleeding and no significant increase in embolic events compared to W. However, given the trend for a higher embolic complication rate with NOAC,a randomized study to evaluate the two anticoagulation strategies is needed, and to determine optimal time to discontinue and resume therapy.
- © 2013 by American Heart Association, Inc.