Uninterrupted trumps interrupted vitamin k antagonists as peri-atrial fibrillation ablation strategy - a network meta-analysis of safety in more than 25000 patients

Introduction Vitamin K antagonists(VKA) are still a widely used method of anticoagulation as a periprocedural strategy for atrial fibrillation(AF) ablation. Several small series have suggested that the uninterrupted (u) VKA strategy is safer than interrupted (iVKA). A meta-analysis with a larger sample size can offer different insights about the safety of both administration regimens. Objective To evaluate the thromboembolic and bleeding events with uVKA and iVKA strategies in a network meta-analysis. Methods A literature search yielded 47 studies that included patients undergoing AF ablation with different anticoagulation strategies. DOACS, uVKA, and iVKA and reported thromboembolic and bleeding complications. A network meta-analysis was used to pool effect sizes among the 3 anticoagulation regimens, with odds ratios (OR) with 95% confidence intervals (CI), and a pairwise meta-analysis using a random effects model. Results A total of 13.303 patients on VKA (uVKA: 9.781; iVKA: 3.522) were compared using 12.972 patients on DOACs. The network analysis showed that both thromboembolic and bleeding complications were higher in patients treated with iVKA than uVKA (OR = 1.38, 95% CI: 1.01–1.87, I² = 0%), and (OR = 1.37, 95% CI: 0.99–1.88, I² = 0%), respectively (Figure1). Conclusions Our network meta analysis shows that administration of interrupted VKA is inferior to uninterrupted VKA in terms of both bleeding and thromboembolic complications. The data supports uVKA as a strategy of choice for periablation anticoagulation.