Department of Medical & Surgical Sciences, University of Foggia, Foggia, Italy.
Division of Electrophysiology, Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Heart Center Luebeck, Luebeck, Germany.
Cardiovasc Drugs Ther. 2020 Apr;34(2):209-214. doi: 10.1007/s10557-020-06947-5.
Catheter ablation (CA) of atrial fibrillation (AF) is an important rhythm control strategy for patients with drug-refractory AF. We aimed to perform an updated meta-analysis of direct oral anticoagulants (DOACs) vs vitamin K antagonists (VKAs) as uninterrupted anticoagulation in patients undergoing AF ablation to assess safety and efficacy of DOAC, after the publication of recent data on edoxaban in CA of AF.
We performed a meta-analysis of RCTs enrolling patients undergoing AF ablation. We assessed Mantel-Haenszel pooled estimates of risk ratios (RRs) and 95% CIs for thromboembolic events, major bleeding (MB), and non-major bleeding (NMB).
A total of 2118 patients have been included in the analysis. Compared with patients receiving VKA, patients receiving DOACs had a lower, although non-significant, risk of thromboembolic events (RR, 0.40; 95% CI, 0.09-1.76; P = 0.23). MB rates in patients treated with DOACs were statistically significantly lower than VKA (RR, 0.61; 95% CI, 0.39-0.93, P = 0.02). The incidence of NMB was not significantly different (RR, 0.98; 95% CI, 0.83-1.57, p n.s.).
In a meta-analysis of RCTs, an uninterrupted DOACs strategy for CA of AF appears to be superior to uninterrupted VKA in terms of safety; a non-significant trend favoring DOACs in terms of efficacy is also evident.
导管消融（CA）治疗心房颤动（AF）是药物难治性 AF 患者的重要节律控制策略。我们旨在对直接口服抗凝剂（DOAC）与维生素 K 拮抗剂（VKA）作为 AF 消融患者不间断抗凝进行更新的荟萃分析，以评估 DOAC 的安全性和有效性，此前发表了关于 AF 消融中依度沙班的最新数据。
我们对接受 AF 消融的 RCT 进行了荟萃分析。我们评估了 Mantel-Haenszel 汇总估计的血栓栓塞事件、大出血（MB）和非主要出血（NMB）风险比（RR）和 95%置信区间（CI）。
共有 2118 例患者纳入分析。与接受 VKA 的患者相比，接受 DOAC 的患者血栓栓塞事件的风险虽然较低，但无统计学意义（RR，0.40；95%CI，0.09-1.76；P=0.23）。与 VKA 相比，接受 DOAC 治疗的患者 MB 发生率显著降低（RR，0.61；95%CI，0.39-0.93，P=0.02）。NMB 的发生率无显著差异（RR，0.98；95%CI，0.83-1.57，p n.s.）。
在 RCT 的荟萃分析中，AF 消融的不间断 DOAC 策略在安全性方面似乎优于不间断 VKA；在疗效方面，也明显倾向于 DOAC。
