Periprocedural use of NOACs significantly reduced the risk of major bleeding compared to VKAs in patients undergoing AF ablation, with RCTs showing a Peto OR of 0.30 (95% CI 0.14-0.62; P=0.001).
Meta-Analysis (n=12,644)
Do NOACs reduce major bleeding or thromboembolic events compared to VKAs in patients undergoing catheter ablation for atrial fibrillation?
Periprocedural use of NOACs during atrial fibrillation ablation is associated with a significantly lower risk of major bleeding compared to VKAs, without increasing thromboembolic risk.
Effect estimate: Peto OR 0.30 (95% CI 0.14-0.62)
p-value: p=0.001
Summary Aims Catheter ablation for atrial fibrillation ( AF ) is associated with a transitory increase in the risk of both thromboembolic and bleeding events. Evidence on the use of nonvitamin K antagonist oral anticoagulants ( NOAC s) in patients undergoing AF ablation mostly comes from small observational studies, underpowered to detect differences in clinical outcomes between NOAC s and vitamin K antagonists (VKAs) treated patients. This updated meta‐analysis aimed to determine the safety and efficacy of periprocedural anticoagulation with NOAC s compared with VKAs in AF patients undergoing catheter ablation. Methods We searched MEDLINE , Cochrane library, and web sources for randomized and observational studies comparing periprocedural treatment with NOAC s and VKA s in patients undergoing AF ablation. The primary safety endpoint was major bleeding events, and the primary efficacy endpoint was thromboembolic events (a composite of systemic thromboembolism, transient ischemic attack, and stroke). Results A total of 29 studies with 12 644 patients were included in the meta‐analysis. Overall, patients on NOAC s had a significantly lower risk of major bleeding compared to VKA s either in observational studies (Peto OR 0.68; 95% CI : 0.48‐0.95; P = 0.022; I 2 = 20%) or in RCT s (Peto OR 0.30; 95% CI : 0.14‐0.62; P = 0.001; I 2 = 28%). Uninterrupted NOAC s reduced the risk of major bleeding when compared to uninterrupted VKA s (Peto OR 0.66; 95% CI : 0.45‐0.96; P = 0.028; I 2 = 1%), similarly, interrupted NOAC s lowered the risk of major bleeding compared to interrupted VKA s (Peto OR 0.29; 95% CI : 0.13‐0.66; P = 0.003; I 2 = 0%; P interaction = 0.076). The rate of thromboembolic complications was very low and did not significantly differ between the study groups either in observational studies (Peto OR 0.91; 95% CI : 0.49‐1.67; P = 0.755; I 2 = 0%) or in RCT s (Peto OR 0.14; 95% CI : 0.01‐1.30; P = 0.083; I 2 = 0%). Conclusions Use of NOAC s compared to VKA s significantly reduced the risk of bleeding in patients with AF ablation. Similarly, the risk of bleeding was lower with uninterrupted NOAC s than with uninterrupted VKA s, and with interrupted NOAC s than with interrupted VKA s. The rate of thromboembolic complications was extremely low in both study groups without any differences.
Ge et al. (Wed,) conducted a meta-analysis in Atrial fibrillation undergoing catheter ablation (n=12,644). Nonvitamin K antagonist oral anticoagulants (NOACs) vs. Vitamin K antagonists (VKAs) was evaluated on Major bleeding events (RCTs) (Peto OR 0.30, 95% CI 0.14-0.62, p=0.001). Periprocedural use of NOACs significantly reduced the risk of major bleeding compared to VKAs in patients undergoing AF ablation, with RCTs showing a Peto OR of 0.30 (95% CI 0.14-0.62; P=0.001).