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New oral anticoagulants compared to warfarin for perioperative anticoagulation in patients undergoing atrial fibrillation catheter ablation: a meta-analysis of continuous or interrupted new oral anticoagulants during ablation compared to interrupted or continuous warfarin

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Abstract

Background

New oral anticoagulants (NOACs) have been shown to be comparable to warfarin in patients with non-valvular atrial fibrillation (AF). This meta-analysis was performed to evaluate the efficacy and safety of NOACs for perioperative anticoagulation of AF catheter ablation.

Methods

PubMed, Embase, the Cochrane Library, CNKI, VIP, and SinoMed were searched for articles published up to August 30, 2015. The data were calculated with RevMan 5.2 using a fixed-effects model.

Results

Nineteen studies with a total of 7996 patients were included in this meta-analysis. NOAC treatment was associated with fewer overall bleeding events than continuous warfarin treatment (RR = 0.78, 95% CI = 0.64–0.95, P = 0.01); similarly, there were fewer overall bleeding events with NOAC treatment than interrupted warfarin treatment (RR = 0.58, 95% CI = 0.44–0.77, P = 0.0002). In the subgroup analyses, the incidence of overall bleeding events (RR = 0.67, 95% CI = 0.48–0.92, P = 0.01) and minor bleeding events (RR = 0.56, 95% CI = 0.37–0.86, P = 0.007) in the interrupted NOAC group was lower than that in the continuous warfarin group. NOAC treatment did not increase the risk of thromboembolic complications compared with warfarin treatment (P > 0.05).

Conclusions

The findings of this meta-analysis suggested that periprocedural NOAC therapy was as effective as continuous warfarin therapy for preventing thromboembolism and had a lower incidence of bleeding complications. Interrupted NOAC therapy during the periprocedural period might result in a lower incidence of bleeding complications compared with continuous NOAC therapy.

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    Authors and Affiliations

    1. Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China

      Yue Zhao, Yuan Yang, Xuejiao Tang, Xiang Yu, Lei Zhang & Hua Xiao

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    1. Yue Zhao
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    2. Yuan Yang
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    Correspondence to Hua Xiao.

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    Yue Zhao and Yuan Yang contributed equally to this work.

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    Zhao, Y., Yang, Y., Tang, X. et al. New oral anticoagulants compared to warfarin for perioperative anticoagulation in patients undergoing atrial fibrillation catheter ablation: a meta-analysis of continuous or interrupted new oral anticoagulants during ablation compared to interrupted or continuous warfarin. J Interv Card Electrophysiol 48, 267–282 (2017). https://doi.org/10.1007/s10840-016-0221-7

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