Yin-Jun Mao1, Hang Wang1, Pin-Fang Huang1. 1. Department of Pharmacy, First Affiliated Hospital of Fujian Medical University, Fuzhou, China.
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.
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.
Authors: Ghada A Bawazeer; Hadeel A Alkofide; Aya A Alsharafi; Nada O Babakr; Arwa M Altorkistani; Tarek S Kashour; Michael Miligkos; Khalid M AlFaleh; Lubna A Al-Ansary Journal: Cochrane Database Syst Rev Date: 2021-10-21
Authors: Indranill Basu-Ray; Dibbendhu Khanra; Péter Kupó; Jared Bunch; Sue A Theus; Anindya Mukherjee; Sumit K Shah; András Komócsi; Adedayo Adeboye; John Jefferies Journal: J Arrhythm Date: 2021-01-29
Authors: Stijn P G van Vugt; Sjoerd W Westra; Rick H J A Volleberg; Gerjon Hannink; Rena Nakamura; Carlo de Asmundis; Gian-Battista Chierchia; Eliano P Navarese; Marc A Brouwer Journal: Europace Date: 2021-12-07 Impact factor: 5.214