title: Meta-analysis of risk of stroke and thrombo-embolism with rivaroxaban versus vitamin K antagonists in ablation and cardioversion of atrial fibrillation.
abstract: BACKGROUND
  Anticoagulation in cardioversion and ablation of atrial fibrillation is imperative for reducing thrombo-embolic events. Ample information is available about the use of warfarin and vitamin K antagonists (VKA) but few trials examine safety and efficacy of rivaroxaban in these procedures. We aim to explore the hypothesis that rivaroxaban causes equal thrombo-embolic and bleeding events when used in atrial fibrillation patients undergoing ablation or cardioversion compared to VKA.
  
  
  METHODS
  We searched the online databases as well as conference abstracts till December 2014 for studies comparing rivaroxaban with VKA in atrial fibrillation patients undergoing catheter ablation or cardioversion. We report events as Odds ratio using random effects model except when event rates were less than 1% we used Peto Odds Ratio.
  
  
  RESULTS
  A total of 8872 atrial fibrillation patients in 15 studies undergoing either catheter ablation or cardioversion were included in this analysis. There were significantly lower stroke events with rivaroxaban compared with VKA (Peto Odds Ratio (POR) 0.33, 95% confidence interval (CI) [0.11, 0.95]; P=0.04), and significantly less thrombo-embolic events with rivaroxaban compared with VKA (POR 0.46, 95% CI [0.21, 0.97]; P=0.04). Major and minor bleeding were equal with rivaroxaban versus VKA (Odds Ratio (OR) 0.92, 95% CI [0.62, 1.36]; P=0.68) and (OR 0.81,95% CI [0.58, 1.11]; P=0.19) respectively.
  
  
  CONCLUSIONS
  The use of rivaroxaban in ablation and cardioversion of atrial fibrillation may be associated with decreased risk of stroke and thromboembolism with equal bleeding risk compared to VKA.
authors.affiliation: Division of Cardiology, University of Arkansas for Medical Sciences, Little Rock, AR, United States. Electronic address: ramez.nairooz@gmail.com.
authors.forename: Ramez
authors.initials: R
authors.lastname: Nairooz
authors.affiliation: Division of Cardiovascular medicine, University of Utah, Salt Lake City, UT, United States.
authors.forename: Partha
authors.initials: P
authors.lastname: Sardar
authors.affiliation: Department of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, United States.
authors.forename: Maria
authors.initials: M
authors.lastname: Pino
authors.affiliation: Division of Cardiology, New-York Medical College-Westchester Medical Center, Valhalla, New York, United States; Division of Cardiology, Texas Tech University Health Sciences Center, El Paso, TX, United States.
authors.forename: Wilbert S
authors.initials: WS
authors.lastname: Aronow
authors.affiliation: Division of Cardiology, University of Arkansas for Medical Sciences, Little Rock, AR, United States.
authors.forename: Asif
authors.initials: A
authors.lastname: Sewani
authors.affiliation: Division of Cardiovascular medicine, University of Utah, Salt Lake City, UT, United States.
authors.forename: Debabrata
authors.initials: D
authors.lastname: Mukherjee
authors.affiliation: Division of Cardiology, University of Arkansas for Medical Sciences, Little Rock, AR, United States.
authors.forename: Hakan
authors.initials: H
authors.lastname: Paydak
authors.affiliation: Division of Cardiology, University of Arkansas for Medical Sciences, Little Rock, AR, United States.
authors.forename: Waddah
authors.initials: W
authors.lastname: Maskoun
mesh_terms: D000925:Anticoagulants / Q000009:adverse effects*; D001281:Atrial Fibrillation / Q000628:therapy*; D017115:Catheter Ablation; D004554:Electric Countershock; D065427:Factor Xa Inhibitors / Q000009:adverse effects*; D005343:Fibrinolytic Agents / Q000009:adverse effects*; D006470:Hemorrhage / Q000139:chemically induced*; D006801:Humans; D012306:Risk; D000069552:Rivaroxaban / Q000009:adverse effects*; D020521:Stroke / Q000139:chemically induced*; D013923:Thromboembolism / Q000139:chemically induced*; D014812:Vitamin K / Q000037:antagonists & inhibitors*
chemical_list: D000925:Anticoagulants; D065427:Factor Xa Inhibitors; D005343:Fibrinolytic Agents; D014812:Vitamin K; D000069552:Rivaroxaban
keywords: Ablation; Anticoagulation; Atrial fibrillation; Cardioversion; Oral anticoagulants