title: Safety and efficacy of dabigatran compared with warfarin for patients undergoing radiofrequency catheter ablation of atrial fibrillation: a meta-analysis.
abstract: BACKGROUND
  The safety and efficacy of dabigatran in the periprocedural period for patients undergoing atrial fibrillation ablation is not well established. We conducted a meta-analysis of the periprocedural use of dabigatran vs warfarin (with or without heparin bridging).
  
  
  METHODS
  A literature search was performed using multiple databases. Outcomes were (1) major bleeding; (2) minor bleeding; and (3) thromboembolic events. Odds ratios (ORs) were reported for dichotomous variables.
  
  
  RESULTS
  Eleven controlled studies (9 cohorts, 1 randomized controlled trial and 1 case-control study; 3841 patients) were identified. Dabigatran was used in 1463 patients, uninterrupted in 223 and held up to 36 hours in the remainder. No significant differences were noted in major bleeding rates between dabigatran and warfarin groups (1.9% vs. 1.6%; OR, 1.04 [95% confidence interval (CI), 0.51-2.13]; P = 0.92). Cardiac tamponade was observed in 1.4% in dabigatran vs 1.1% in warfarin groups (OR, 1.1; 95% CI, 0.55-2.11; P = 0.82). Similar rates for dabigatran vs. warfarin were reported for minor bleeding (3.8% vs. 4.5%; OR, 0.85; 95% CI, 0.58-1.25; P = 0.40), hematoma (2% vs. 2.7%; OR, 0.67; 95% CI, 0.41-1.08; P = 0.1), and thromboembolic events (0.6% vs. 0.1%; OR, 2.51; 95% CI, 0.78-8.11; P = 0.12).
  
  
  CONCLUSIONS
  This meta-analysis suggests that dabigatran and warfarin have similar safety and efficacy overall for periprocedural anticoagulation in patients undergoing radiofrequency atrial fibrillation ablation. Signals were seen favouring dabigatran (for hematomas) and warfarin (for thromboembolic events), but neither was statistically significant because of low event rates. More high-quality data are required to definitively compare the 2 strategies.
authors.affiliation: Arrhythmia Services, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada. Electronic address: Mohammed.Shurrab@sunnybrook.ca.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Shurrab
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Morillo
authors.forename: Sam
authors.initials: S
authors.lastname: Schulman
authors.forename: Nitin
authors.initials: N
authors.lastname: Kansal
authors.forename: Asaf
authors.initials: A
authors.lastname: Danon
authors.forename: David
authors.initials: D
authors.lastname: Newman
authors.forename: Ilan
authors.initials: I
authors.lastname: Lashevsky
authors.forename: Jeff S
authors.initials: JS
authors.lastname: Healey
authors.forename: Eugene
authors.initials: E
authors.lastname: Crystal
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; D019990:Perioperative Care / Q000379:methods*; D020521:Stroke / Q000209:etiology / Q000517:prevention & control*; 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