Peri-procedural novel oral anticoagulants dosing strategy during atrial fibrillation ablation: A meta-analysis

Abstract

Background: This study aimed at determining whether uninterrupted novel oral anticoagulant (UI-NOAC) would have similar rates of bleeding and thromboembolic events as minimally interrupted NOAC (MI-NOAC) at the time of ablation for atrial fibrillation (AF) as relevant studies are scarce.

Methods: We searched through the PubMed, EMBASE, and Cochrane Library databases for prospective observational studies (POSs) or randomised controlled trials (RCTs) comparing UI-NOAC versus MI-NOAC from their establishment to January 2020. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated to compare the pooled treatment effect.

Results: Nine studies (three POSs and six RCTs) with 2578 patients were included in the final analysis (55% patients received MI-NOAC). No significant difference was found regarding the risk of major bleeding (OR 0.92, 95% CI 0.43-2.00, P = .84, I² = 0%). Both groups were comparable in all subgroups ([Asians: OR 1.00, 95% CI 0.43-2.36, P = .99, I² = 0%], [non-Asians: OR 0.64, 95% CI 0.11-3.88, P = .63, I² = 0%], [RCTs: OR 0.85, 95% CI 0.37-1.97, P = .71, I² = 0%], and [POSs: OR 0.52, 95% CI 0.19-12.01, P = .69, I² = 0%]). The risk of minor bleeding (P = .88) or stroke (P = .69) was comparable between the groups. UI-NOAC resulted in a significant reduction in silent stroke (SS) (OR 0.44, 95% CI 0.23-0.83, P = .01, I² = 72%). No significant difference was found in SS between once-daily and twice-daily NOACs (OR 0.91, 95% CI 0.63-1.33, P = .64, I² = 0%) in the MI-NOAC group.

Conclusions: UI-NOAC, as a peri-procedural anticoagulation strategy for catheter ablation in AF, had similar safety compared with MI-NOAC, but was advantageous in terms of SS.

Keywords: atrial fibrillation; bleeding; catheter ablation; novel oral anticoagulant; peri-procedural anticoagulation.