Safety and efficacy of dabigatran etexilate during catheter ablation of atrial fibrillation: a meta-analysis of the literature

AIMS: To summarize and analyse the published literature on the efficacy and safety of dabigatran for anticoagulation during atrial fibrillation (AF) ablation. METHODS AND RESULTS: A comprehensive search of the literature in the English language was conducted and 10 studies were identified which compared dabigatran therapy with warfarin. Data were extracted and meta-analysed using appropriate methodology. There was significant clinical heterogeneity among studies concerning study designs and methodologies. Most studies consisted of retrospective single-centre observational studies. A total of 3648 patients were included of whom 2241 were receiving warfarin and 1407 dabigatran. Only 12 thrombo-embolic events were reported, 3 during warfarin and 9 during dabigatran therapy [odds ratio (OR) 2.38, 95% confidence interval (CI) 0.82-6.85, P = n.s.). The pooled rate of major bleeding events was similar for warfarin and for dabigatran (OR 1.05, 95% CI 0.62-1.80; P = n.s.). Rates of minor bleeding events were also similar between the two treatment groups. CONCLUSION: Dabigatran has similar efficacy and safety compared with warfarin when used for periprocedural anticoagulation during AF ablation.