Meta‐Analysis of Efficacy and Safety of Apixaban in Patients Undergoing Catheter Ablation for Atrial Fibrillation

Dasheng Lu; Qian Liu; Kai Wang; Qi Zhang; Qijun Shan

doi:10.1111/pace.12771

October 23, 2015Pacing and Clinical Electrophysiology

Meta‐Analysis of Efficacy and Safety of Apixaban in Patients Undergoing Catheter Ablation for Atrial Fibrillation

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Why the study?

Does apixaban improve safety and efficacy compared to vitamin K antagonists in patients undergoing catheter ablation for atrial fibrillation?

Structured PICO

Does apixaban improve safety and efficacy compared to vitamin K antagonists in patients undergoing catheter ablation for atrial fibrillation?

P

Population

Patients undergoing catheter ablation (CA) for atrial fibrillation (AF) (4 studies included)

I

Intervention

Apixaban

C

Comparator

Vitamin K antagonists (VKAs)

O

Outcome

Rates of total bleeding, thromboembolic complications, total events, and major bleeding in the periprocedural periodsafety

Apixaban appears as effective and safe as vitamin K antagonists during the periprocedural period of catheter ablation for atrial fibrillation.

Implication

Evidence on apixaban for AF ablation remains sparse; leaves open optimal periprocedural strategy.

Abstract

BACKGROUND: The efficacy and safety of apixaban in patients undergoing catheter ablation (CA) for atrial fibrillation (AF) are little investigated. METHODS: The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and EMBASE were searched up to September 2015. Four literatures comparing apixaban with vitamin K antagonists (VKAs) were included. Data were pooled in Review Manager Software, using Mantel-Haenszel methods with a fixed-effects model. The funnel plots and Egger's test were used to examine publication bias. Heterogeneity was assessed using the I(2) test. Risk ratios (RR) and 95% confidence intervals (CI) of each study were calculated and pooled. RESULTS: No significant differences were observed in rates of total bleeding (RR = 0.91, 95% CI [0.57, 1.46], I(2) = 0.0%), thromboembolic complications (RR = 0.75, 95% CI [0.03, 18.22], I(2) = 0.0%), or total events (RR = 0.90, 95% CI [0.56, 1.44], I(2) = 0.0%) between apixaban and VKAs group. The frequency of major bleeding was similar between apixaban and VKAs group (RR = 1.34, 95% CI [0.34, 5.30], I(2) = 0.0%). CONCLUSION: Apixaban was as effective and safe as VKAs in the periprocedural period of CA.