Dipartimento di Cardiologia, Ospedale Generale Regionale 'F. Miulli', Bari, Italy.
J Cardiovasc Med (Hagerstown). 2020 Jul;21(7):483-490. doi: 10.2459/JCM.0000000000000939.
Uninterrupted anticoagulation is recommended during the ablation of atrial fibrillation. This meta-analysis compared the safety and efficacy of uninterrupted direct oral anticoagulants (DOACs) to uninterrupted vitamin K antagonists (VKAs) during atrial fibrillation ablation.
The meta-analysis included eligible randomized controlled trials from 2009 to 2019. Odds ratios (ORs) and 95% confidence intervals were pooled using a random effects model and a sensitivity analysis was performed by sequentially removing one study or DOAC at a time.
Six studies were included; 1288 received DOAC and 1081 VKA. Pooled ORs indicated a lower nonsignificant incidence in DOACs vs. VKA of composite outcome of major bleeding, stroke, or transient ischemic attack, and mortality (0.69; 0.28-1.71; 31 vs. 45 events), major bleeding alone (0.66; 0.30-1.47; 27 vs. 41 events), and cardiac tamponade (0.56; 0.21-1.45; eight vs. 13 events) with a slightly higher occurrence of minor bleeding (1.17; 0.89-1.56; 139 vs. 106 events) and silent cerebral thromboembolic events (1.12; 0.75-1.66; 72 vs. 58 among 442 and 376 patients performing MRI study). Sensitivity analyses confirmed overall results: pooled ORs ranged from 0.56 to 1.00 for the composite outcome and from 0.54 to 0.92 for major bleedings.
Uninterrupted DOAC is a safe and effective alternative to uninterrupted VKA during atrial fibrillation ablation.
在房颤消融期间推荐不间断抗凝。本荟萃分析比较了房颤消融期间不间断直接口服抗凝剂（DOAC）与不间断维生素 K 拮抗剂（VKA）的安全性和疗效。
该荟萃分析纳入了 2009 年至 2019 年期间的合格随机对照试验。使用随机效应模型汇总比值比（OR）和 95%置信区间，并通过依次逐个去除一项研究或 DOAC 进行敏感性分析。
共纳入 6 项研究；1288 例患者接受 DOAC 治疗，1081 例患者接受 VKA 治疗。汇总 OR 表明，DOAC 组与 VKA 组复合终点（主要出血、卒中和短暂性脑缺血发作以及死亡率）、大出血单独（0.66；0.30-1.47；27 例 vs. 41 例）、心脏压塞（0.56；0.21-1.45；8 例 vs. 13 例）的发生率较低，但轻微出血（1.17；0.89-1.56；139 例 vs. 106 例）和无症状性脑血栓栓塞事件（1.12；0.75-1.66；442 例和 376 例接受 MRI 研究的患者中分别为 72 例和 58 例）发生率略高。敏感性分析证实了总体结果：复合终点的汇总 OR 范围为 0.56 至 1.00，大出血的汇总 OR 范围为 0.54 至 0.92。
房颤消融期间不间断使用 DOAC 是不间断使用 VKA 的安全有效替代方案。
