Significant Benefit of Uninterrupted DOACs Versus VKA During Catheter Ablation of Atrial Fibrillation.

Abstract

OBJECTIVES\nThis study assessed the incremental benefit of uninterrupted direct oral anticoagulants (DOACs) versus uninterrupted vitamin K antagonists (VKAs) for catheter ablation (CA) of nonvalvular atrial fibrillation (NVAF) on 3 primary outcomes: major bleeding events (MBEs), minor bleeding events, and thromboembolic events (TEs). The secondary outcome was post-procedural silent cerebral infarction (SCI) as detected by brain cardiac magnetic resonance.\n\n\nBACKGROUND\nAs a class, evidence of the benefits of DOACs versus VKAs during CA of AF is scant.\n\n\nMETHODS\nA systematic review of Medline, Cochrane, and Embase was done to find all randomized controlled trials in which uninterrupted DOACs were compared against uninterrupted VKAs for CA of NVAF. A fixed-effect model was used, except when I2 was\xa0≥25, in which case, a random effects model was used.\n\n\nRESULTS\nThe benefit of uninterrupted DOACs over VKAs was analyzed from 6 randomized control trials that enrolled a total of 2,256 patients (male: 72.7%) with NVAF, finding significant benefit in MBEs (relative risk [RR]: 0.45; 95% confidence interval [CI]: 0.20 to 0.99; p\xa0=\xa00.05). No significant differences were found in minor bleeding events (RR: 1.12; 95%\xa0CI: 0.87 to 1.43; p\xa0=\xa00.39), TEs (RR: 0.75; 95%\xa0CI: 0.26 to 2.14; p\xa0=\xa00.59), or post-procedural SCI (RR: 1.09; 95%\xa0CI: 0.80 to 1.49; p\xa0=\xa00.58).\n\n\nCONCLUSIONS\nAn uninterrupted DOACs strategy for CA of AF appears to be safer than uninterrupted VKAs with a decreased rate of major bleeding events. There are no significant differences among the other outcomes. DOACs should be offered as a first-line therapy to patients undergoing CA of AF, due to their lower risk of major bleeding events, ease of use, and fewer interactions.