Abstract 12543: Efficacy and Safety of Rivaroxaban in Patients Undergoing Atrial Fibrillation Ablation: Evidence From a Meta-Analysis
Background: Rivaroxaban is an alternative to warfarin in stroke prevention for non-valvular atrial fibrillation, however safety and efficacy of rivaroxaban in patients undergoing catheter ablation has not been well studied. We aim to investigate the hypothesis that rivaroxaban is equally safe and effective compared to warfarin when used in patients undergoing atrial fibrillation ablation.
Methods: We reviewed online databases through April 30, 2013 for published articles and conference abstracts comparing rivaroxaban to warfarin in patients undergoing atrial fibrillation ablation. We then performed a meta-analysis to assess safety and efficacy outcomes (Table), using Peto odds ratio, for outcomes with low events rates (<1%).
Results: Our search yielded 5 observational studies; 3 full text articles and 2 conference abstracts. Outcomes data were available for 1691 patients and of those 736 were given rivaroxaban. In 3 of the trials, patients underwent ablation on uninterrupted warfarin. The risk of all thromboembolic events was equal between the two groups; 0.4% with rivaroxaban and 0.8% with warfarin [Peto’s odds ratio (POR) 0.50, 95% confidence interval (CI) 0.14- 1.71; p=0.27]. The risk of stroke with rivaroxaban was also comparable to warfarin (POR 0.30, 95% CI 0.05, 1.77; p=0.19). A trend of lower major bleeding risk was observed with rivaroxaban compared to warfarin (1.2% versus 2.1%; OR 0.50, 95% CI 0.23- 1.08); p=0.08). Minor bleeding was no different (3.8% versus 4.6; OR 0.97. 95% CI 0.59-1.61; p=0.91)
Conclusion: In patients with atrial fibrillation undergoing ablation, rivaroxaban appears equally effective compared to warfarin, and had a trend for lower major bleeding risk.
Author Disclosures: R. Nairooz: None. P. Sardar: None. S. Chatterjee: None. W.S. Aronow: None. D. Mukherjee: None.
- © 2014 by American Heart Association, Inc.