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.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 Cardiol+Ther
2016 ; 5
(1
): 85-100
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Efficacy and Safety of Novel Oral Anticoagulants for Atrial Fibrillation
Ablation: An Updated Meta-Analysis
#MMPMID27105998
Vallakati A
; Sharma A
; Madmani M
; Reddy M
; Kanmanthareddy A
; Gunda S
; Lakkireddy D
; Lewis WR
Cardiol Ther
2016[Jun]; 5
(1
): 85-100
PMID27105998
show ga
INTRODUCTION: Novel oral anticoagulants (NOACs) have been approved for prevention
of stroke and systemic embolism in patients with non-valvular atrial fibrillation
(NVAF). A large number of patients are on NOACs when they present for AF
ablation. We intended to evaluate the safety and efficacy of NOACs for AF
ablation during the periprocedural period by performing a meta-analysis of trials
comparing NOACs with warfarin. METHODS: Studies comparing NOACs (dabigatran and
rivaroxaban) with warfarin as periprocedural anticoagulants for AF ablation were
identified using an electronic search. Primary outcomes were: (1) a composite
endpoint of stroke, transient ischemic attack (TIA), peripheral arterial
embolism, or silent cerebral lesions on magnetic resonance imaging (MRI) and (2)
major bleeding complications. A random effects model was used to pool the safety
and efficacy data across all included trials. RESULTS: When compared to warfarin,
there was an increased risk of the composite endpoint of stroke, TIA, peripheral
arterial embolism, or silent cerebral lesions on MRI with NOACs as periprocedural
anticoagulants for AF ablation [odds ratio (OR): 1.69, 95% confidence interval
(CI): 1.06-2.68]. Sub-group analysis revealed a higher risk of composite endpoint
with dabigatran as a periprocedural anticoagulant for AF ablation (OR: 2.01,
95% CI: 1.19-3.39) whereas the risk was similar with rivaroxaban (OR: 0.90,
95% CI: 0.34-2.41). Sensitivity analysis after excluding silent cerebral lesions
on MRI showed there was no increased risk of thromboembolic events with either
dabigatran (OR: 1.69, 95% CI: 0.81-3.51) or rivaroxaban (OR: 0.70, 95% CI:
0.12-4.04). Risk of bleeding with NOACs was similar to warfarin (OR: 0.91,
95% CI: 0.62-1.34). CONCLUSION: NOACs are comparable to warfarin in terms of
bleeding complications. However, dabigatran therapy is potentially associated
with a higher risk of silent cerebral lesions on MRI. The results of this study
should be considered as hypothesis-generating and assessed further in prospective
randomized clinical studies.
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