Abstract 14926: Uninterrupted Novel Oral Anticoagulants vs Uninterrupted Warfarin Peri-Ablation of Atrial Fibrillation: A Meta-Analysis of Embolic and Bleeding Complications
Introduction: Novel oral anticoagulants (NOACs) like dabigatran (D), rivaroxaban (R) or apixaban (A), are being used much more commonly pre and post-atrial fibrillation (AF) ablation. Many prior reports have included patients with NOACs held for varying periods before, after or both relative to ablation. It is unclear if uninterrupted (U) NOACs increase procedural risk vs the preferred peri-ablation regimen, uninterrupted warfarin (UW). Because individual studies may be too small given low complication rates, we conducted a meta-analysis to provide more robust data to guide current practice
Methods: All published papers (n=4) and abstracts (n=5) to date that compared complication rates for peri-AF ablation use of U-NOACs vs. UW were included. Bleeding complications included pericardial effusion and vascular bleeding, and embolic complications included stroke/TIA or systemic embolism. The Mantel-Haenszel fixed effect model for pooling the study results was used, with a random effects model for heterogeneous samples/results.
Results: The 1404 pts on a U-NOACs (15% D, 59% R, 26% A) were similar to the 1528 pts on UW. There was no difference in composite total complication rates between the 2 groups (6.4% U-NOACs vs 7.7% UW), (OR 0.78, 95% CI 0.58 - 1.05; I2 = 0%). Composite embolic and bleeding rates were similar in both groups (0.14% in U-NOACs vs 0.20% in UW, OR 0.99, 95% CI 0.25 - 4.06; I2 = 0%; and 6.3% in U-NOACs vs 7.5% in UW, OR 0.78, 95% CI 0.58 - 1.06; I2 = 0%, respectively, Figure).
Conclusions: This meta-analysis demonstrates that U-NOACs are a legitimate alternative for peri-AF ablation anticoagulation with no significant difference in bleeding or embolic events compared to UW.
Author Disclosures: D.L. Musat: None. N.V. Garikipati: None. M.W. Preminger: None. T. Sichrovsky: None. S. Mittal: Honoraria; Significant; Boston Scientific. Consultant/Advisory Board; Significant; Boston Scientific. J.S. Steinberg: Research Grant; Modest; Pfizer. Speakers Bureau; Modest; Pfizer. Consultant/Advisory Board; Modest; Pfizer.
- © 2015 by American Heart Association, Inc.