title: Safety and efficacy of dabigatran versus warfarin in patients undergoing catheter ablation of atrial fibrillation: a systematic review and meta-analysis.
abstract: BACKGROUND
  Dabigatran etexilate, a new thrombin inhibitor, has been shown to be comparable to warfarin in patients with atrial fibrillation (AF). However, there is a limited body of evidence on the efficacy and safety of using dabigatran among patients undergoing AF catheter ablation.
  
  
  OBJECTIVE
  A random effects meta-analysis was performed of controlled trials comparing dabigatran and warfarin in paroxysmal/persistent AF patients undergoing catheter ablation.
  
  
  METHODS
  Data sources included Medline, Embase, and Cochrane (from inception to April 2013). Three independent reviewers selected studies comparing warfarin to dabigatran. Descriptive and quantitative information was extracted from each selected study, regarding periprocedural all cause mortality, thromboembolic events and major bleeding, as well as modalities of periprocedural anticoagulation bridging.
  
  
  RESULTS
  After a detailed screening of 228 search results, 14 studies were identified enrolling a total of 4782 patients (1823 treated with dabigatran and 2959 with warfarin). No deaths were reported. No significant differences were found between patients treated with dabigatran and warfarin as regards thromboembolic events (0.55% dabigatran vs 0.17% warfarin; risk ratios (RR)=1.78, 95% CI 0.66 to 4.80; p=0.26) and major bleeding (1.48% dabigatran vs 1.35% warfarin; RR=1.07, 95% CI 0.51 to 2.26; p=0.86). No difference was found between the 110 mg twice daily and 150 mg twice daily dabigatran dosages concerning major bleeding (0% vs 1.62%, respectively; RR=0.19, 95% CI 0.01 to 3.18; p=0.25) and thromboembolism (0% vs 0.40%, respectively; RR=0.72, 95% CI 0.04 to 12.98; p=0.82).
  
  
  CONCLUSIONS
  In the specific setting of AF catheter ablation, this first pooled analysis suggests that patients treated with dabigatran have a similar incidence of thromboembolic events and major bleeding compared to warfarin, with low event rates overall.
authors.affiliation: Département de Rythmologie, Clinique Pasteur, , Toulouse, France.
authors.forename: Rui
authors.initials: R
authors.lastname: Providência
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Albenque
authors.forename: Stephane
authors.initials: S
authors.lastname: Combes
authors.forename: Abdeslam
authors.initials: A
authors.lastname: Bouzeman
authors.forename: Benjamin
authors.initials: B
authors.lastname: Casteigt
authors.forename: Nicolas
authors.initials: N
authors.lastname: Combes
authors.forename: Kumar
authors.initials: K
authors.lastname: Narayanan
authors.forename: Eloi
authors.initials: E
authors.lastname: Marijon
authors.forename: Serge
authors.initials: S
authors.lastname: Boveda
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use; D000991:Antithrombins / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000150:complications / Q000601:surgery*; D001562:Benzimidazoles / Q000627:therapeutic use*; D017115:Catheter Ablation; D000069604:Dabigatran; D006801:Humans; D011300:Preoperative Care / Q000379:methods*; D013923:Thromboembolism / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome; D014859:Warfarin / Q000627:therapeutic use*; D015091:beta-Alanine / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D000991:Antithrombins; D001562:Benzimidazoles; D015091:beta-Alanine; D014859:Warfarin; D000069604:Dabigatran