Systematic Review/Meta-analysisUninterrupted New Oral Anticoagulants Compared With Uninterrupted Vitamin K Antagonists in Ablation of Atrial Fibrillation: A Meta-analysis
Section snippets
Data sources and search strategy
We searched the online databases including PubMed, Cochrane CENTRAL, EMBASE, Web of Science, and CINAHL databases through May 2015 for observational and randomized studies published in English that compared uninterrupted NOAC with uninterrupted VKA in patients who underwent ablation of atrial fibrillation. Two reviewers (K.A., R.N.) identified studies that met the following inclusion criteria: (1) cohort and randomized studies published in the English language; (2) full-length article; (3)
Results
Our search strategy started with screening a total of 557 possible articles for inclusion. After excluding studies that did not meet inclusion and/or exclusion criteria, 8 studies were included in the final analysis (Fig. 1). Of those, only 1 study was a randomized controlled trial15 and the rest were observational studies.5, 6, 7, 16, 17, 18, 19 A total of 3544 atrial fibrillation patients who underwent ablation procedures were included in this analysis. Compared with the 1800 patients in the
Discussion
To our knowledge, this is the first meta-analysis to investigate safety and efficacy of uninterrupted anticoagulation periablation of atrial fibrillation, with a comparison of NOACs with VKAs and including 3544 patients, making it the largest report on the topic. Thromboembolic complications are of very low incidence, estimated to be < 1%, and with uninterrupted anticoagulation as in this analysis, it was 0.16%. This low event rate created a statistical challenge for studies comparing
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2018, ChestCitation Excerpt :Although these studies were open-label, they strongly support the use of uninterrupted anticoagulation for electrophysiology procedures (Table 9).298-301 Two recent systematic reviews with meta-analyses that include studies with such patients consistent with results.302,303 Clinical observations indicate that AF and stroke are often temporally discordant, with stroke occurring during periods of sinus rhythm in the majority of patients with paroxysmal AF.304,305
Anesthesia for Cardiac Ablation
2018, Journal of Cardiothoracic and Vascular AnesthesiaCitation Excerpt :They have similar or less bleeding risk than continuous warfarin therapy with similar rates of thromboembolic events.75 In a meta-analysis, no difference was detected between continuous warfarin therapy and continuous NOAC therapy.5 NOACs have multiple benefits over vitamin K antagonists, including fewer drug and food interactions, less interindividual variability, shorter half-lives, and a decreased need for blood sampling.
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