Peri-procedural novel oral anticoagulants dosing strategy during atrial fibrillation ablation: A meta-analysis

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.

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.

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.

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.