Abstract 15702: Oral Anticoagulation Therapy After Radiofrequency Ablation of Atrial Fibrillation and the Risk of Thromboembolism and Serious Bleeding: A Meta-analysis
Background: Many observational and retrospective studies showed safety of discontinuation of oral anticoagulation (OAT) in radiofrequency ablation (RFA) of atrial fibrillation (AF). We performed a meta-analysis comparing the effect on stroke/systemic thromboembolism (STE) and major bleeding events (MBE) in low risk (CHADS2 0-1) and high risk patients (CHADS2 ≥2) who underwent RFA for AF and stopped or continued OAT.
Methods: We performed a comprehensive literature search using: OAT, RFA and AF in Pubmed, Ebsco and google scholar databases. The analysis in low risk (LR) patients included a total of 6 studies (4 prospective observational and two retrospective studies) and 7 studies (5 prospective observational and 2 retrospective studies) in high risk (HR) patients comparing STE and MBE between patients who discontinued and continued OAT after RFA for AF. OAT was discontinued at 3-6 months after RFA in all studies. Follow-up duration for studies ranged from 1 to 5 years.
Results: Baseline characteristics, procedural details and patient’s follow up were similar across all studies. Majority of patients who discontinued OAT remained in sinus rhythm on follow up. LR included 3,552 no-OAT patients and 2,098 on OAT. HR consisted of 1,258 no-OAT patients and 799 on OAT. Post-procedural complications include STE and MBE at any time during follow up. In LR, STE (11/3552 vs. 14/2098, p=0.15) was similar between both groups while MBE (1/3552 vs. 22/2098, p<0.0001) were significantly lower in patients with no OAT versus OAT group (Fig 1A,B). In HR, both STE (8/1258 vs. 18/799, p=0.01) and MBE (1/824 vs. 21/681, p<0.004) were significantly lower in patients on no-OAT versus OAT (Fig 2A,B).
Conclusion: Our meta-analysis, among patients with low and high CHADS2 score undergoing RFA for AF, continuing OAT was associated with significantly increased risk of MBE. Furthermore, OAT did not decrease the risk of STE in patients in both low and high CHADS2 score who remained in sinus rhythm.
Fig 2 A,B
Author Disclosures: M. Turagam: None. P. Velagapudi: None. M. Lavu: None. S. Iskandar: None. D. Atkins: None. S. Bommana: None. L. Di Biase: None. A. Natale: None. D. Lakkireddy: None. M. Reddy: None.
- © 2016 by American Heart Association, Inc.