Ottóffy Máté, Mátrai Péter, Farkas Nelli, Hegyi Péter, Czopf László, Márta Katalin, Garami András, Balaskó Márta, Pótóné-Oláh Emőke, Mikó Alexandra, Rostás Ildikó, Wobbe Bastian, Habon Tamás
First Department of Medicine, Division of Cardiology, Medical School, University of Pécs, 7622 Pécs, Hungary.
Institute for Translational Medicine, Medical School, University of Pécs, 7622 Pécs, Hungary.
J Clin Med. 2020 Sep 24;9(10):3073. doi: 10.3390/jcm9103073.
Adequate anticoagulation during catheter ablation (CA) for atrial fibrillation (AF) is crucial for the prevention of both thromboembolic events and life-threatening bleeding. The purpose of this updated meta-analysis is to compare the safety and efficacy of uninterrupted and minimally interrupted periprocedural direct oral anticoagulant (DOAC) protocols and uninterrupted vitamin K antagonist (VKA) therapy in patients undergoing CA for AF based on the latest evidence. Randomized controlled trials, prospective observational studies, and retrospective registries comparing DOACs to VKAs were identified in multiple databases (Embase, MEDLINE via PubMed, CENTRAL, and Scopus). The primary outcomes were stroke or transient ischemic attack (TIA), major bleeding, and net clinical benefit. Forty-two studies with a total of 22,715 patients were included in the final analysis. The occurrence of major bleeding was significantly lower in patients assigned to uninterrupted DOAC treatment compared to VKAs (pooled odds ratio (POR): 0.71, confidence interval (CI): 0.51-0.99). The pooled analysis of both uninterrupted and minimally interrupted DOAC groups also showed significant reduction in major bleeding events (POR: 0.70, CI: 0.53-0.93). The incidence of thromboembolic events was low, with no significant difference between groups. This updated meta-analysis showed that DOAC therapy is as effective as VKA in preventing stroke and TIA. Minimally interrupted DOAC therapy is a non-inferior periprocedural anticoagulation strategy; however, uninterrupted DOAC therapy showed superiority compared to VKA with regard to major, life-threatening bleeding. Based on our in-depth analysis, we conclude that both DOAC strategies are equally safe and preferable alternatives to VKAs in patients undergoing CA for AF.
在心房颤动（AF）导管消融（CA）过程中进行充分抗凝对于预防血栓栓塞事件和危及生命的出血至关重要。这项更新的荟萃分析的目的是根据最新证据，比较在接受AF-CA的患者中，围手术期不间断和轻度中断直接口服抗凝剂（DOAC）方案与不间断维生素K拮抗剂（VKA）治疗的安全性和有效性。在多个数据库（Embase、通过PubMed的MEDLINE、CENTRAL和Scopus）中检索了比较DOAC与VKA的随机对照试验、前瞻性观察性研究和回顾性登记研究。主要结局为中风或短暂性脑缺血发作（TIA）、大出血和净临床获益。最终分析纳入了42项研究，共22715例患者。与VKA相比，接受不间断DOAC治疗的患者大出血发生率显著更低（合并比值比（POR）：0.71，置信区间（CI）：0.51-0.99）。不间断和轻度中断DOAC组的汇总分析也显示大出血事件显著减少（POR：0.70，CI：0.53-0.93）。血栓栓塞事件的发生率较低，组间无显著差异。这项更新的荟萃分析表明，DOAC治疗在预防中风和TIA方面与VKA同样有效。轻度中断DOAC治疗是一种非劣效的围手术期抗凝策略；然而，在严重的、危及生命的出血方面，不间断DOAC治疗与VKA相比显示出优越性。基于我们的深入分析，我们得出结论，在接受AF-CA的患者中，两种DOAC策略与VKA相比同样安全且更可取。
