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.

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.