Lower Major Bleeding Rates with Direct Oral Anticoagulants in Catheter Ablation of Atrial Fibrillation: an Updated Meta-analysis of Randomized Controlled Studies
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Lower Major Bleeding Rates with Direct Oral Anticoagulants in Catheter Ablation of Atrial Fibrillation: an Updated Meta-analysis of Randomized Controlled Studies. / Brunetti, Natale Daniele; Tricarico, Lucia; Tilz, Roland R; Heeger, Christian-H; De Gennaro, Luisa; Correale, Michele; Ieva, Riccardo; Di Biase, Matteo; Rillig, Andreas; Metzner, Andreas; Santoro, Francesco.
in: CARDIOVASC DRUG THER, Jahrgang 34, Nr. 2, 04.2020, S. 209-214.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Review › Forschung
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TY - JOUR
T1 - Lower Major Bleeding Rates with Direct Oral Anticoagulants in Catheter Ablation of Atrial Fibrillation: an Updated Meta-analysis of Randomized Controlled Studies
AU - Brunetti, Natale Daniele
AU - Tricarico, Lucia
AU - Tilz, Roland R
AU - Heeger, Christian-H
AU - De Gennaro, Luisa
AU - Correale, Michele
AU - Ieva, Riccardo
AU - Di Biase, Matteo
AU - Rillig, Andreas
AU - Metzner, Andreas
AU - Santoro, Francesco
PY - 2020/4
Y1 - 2020/4
N2 - INTRODUCTION: Catheter ablation (CA) of atrial fibrillation (AF) is an important rhythm control strategy for patients with drug-refractory AF. We aimed to perform an updated meta-analysis of direct oral anticoagulants (DOACs) vs vitamin K antagonists (VKAs) as uninterrupted anticoagulation in patients undergoing AF ablation to assess safety and efficacy of DOAC, after the publication of recent data on edoxaban in CA of AF.METHODS: We performed a meta-analysis of RCTs enrolling patients undergoing AF ablation. We assessed Mantel-Haenszel pooled estimates of risk ratios (RRs) and 95% CIs for thromboembolic events, major bleeding (MB), and non-major bleeding (NMB).RESULTS: A total of 2118 patients have been included in the analysis. Compared with patients receiving VKA, patients receiving DOACs had a lower, although non-significant, risk of thromboembolic events (RR, 0.40; 95% CI, 0.09-1.76; P = 0.23). MB rates in patients treated with DOACs were statistically significantly lower than VKA (RR, 0.61; 95% CI, 0.39-0.93, P = 0.02). The incidence of NMB was not significantly different (RR, 0.98; 95% CI, 0.83-1.57, p n.s.).CONCLUSIONS: In a meta-analysis of RCTs, an uninterrupted DOACs strategy for CA of AF appears to be superior to uninterrupted VKA in terms of safety; a non-significant trend favoring DOACs in terms of efficacy is also evident.
AB - INTRODUCTION: Catheter ablation (CA) of atrial fibrillation (AF) is an important rhythm control strategy for patients with drug-refractory AF. We aimed to perform an updated meta-analysis of direct oral anticoagulants (DOACs) vs vitamin K antagonists (VKAs) as uninterrupted anticoagulation in patients undergoing AF ablation to assess safety and efficacy of DOAC, after the publication of recent data on edoxaban in CA of AF.METHODS: We performed a meta-analysis of RCTs enrolling patients undergoing AF ablation. We assessed Mantel-Haenszel pooled estimates of risk ratios (RRs) and 95% CIs for thromboembolic events, major bleeding (MB), and non-major bleeding (NMB).RESULTS: A total of 2118 patients have been included in the analysis. Compared with patients receiving VKA, patients receiving DOACs had a lower, although non-significant, risk of thromboembolic events (RR, 0.40; 95% CI, 0.09-1.76; P = 0.23). MB rates in patients treated with DOACs were statistically significantly lower than VKA (RR, 0.61; 95% CI, 0.39-0.93, P = 0.02). The incidence of NMB was not significantly different (RR, 0.98; 95% CI, 0.83-1.57, p n.s.).CONCLUSIONS: In a meta-analysis of RCTs, an uninterrupted DOACs strategy for CA of AF appears to be superior to uninterrupted VKA in terms of safety; a non-significant trend favoring DOACs in terms of efficacy is also evident.
KW - Administration, Oral
KW - Anticoagulants/administration & dosage
KW - Atrial Fibrillation/diagnosis
KW - Catheter Ablation/adverse effects
KW - Factor Xa Inhibitors/administration & dosage
KW - Female
KW - Hemorrhage/chemically induced
KW - Humans
KW - Male
KW - Middle Aged
KW - Randomized Controlled Trials as Topic
KW - Risk Assessment
KW - Risk Factors
KW - Thromboembolism/diagnosis
KW - Time Factors
KW - Treatment Outcome
KW - Vitamin K/antagonists & inhibitors
KW - Warfarin/administration & dosage
U2 - 10.1007/s10557-020-06947-5
DO - 10.1007/s10557-020-06947-5
M3 - SCORING: Review article
C2 - 32080786
VL - 34
SP - 209
EP - 214
JO - CARDIOVASC DRUG THER
JF - CARDIOVASC DRUG THER
SN - 0920-3206
IS - 2
ER -