title: Periprocedural Management of New Oral Anticoagulants in Atrial Fibrillation Ablation.
abstract: BACKGROUND
  Patients who undergo catheter ablation for atrial fibrillation (AF) are at increased risk of developing thromboembolic and bleeding complications periprocedurally. Many patients are now on newer oral anticoagulants (NOACs), but data regarding their safety and efficacy during AF ablation are limited.
  
  
  RESULTS
  This article reviews the literature in PubMed from 1998 to 2014 and includes clinical trials and meta-analysis that analyzed the safety and efficacy of NOACs during AF catheter ablation. Dabigatran seems to be as effective and safe as warfarin, although most data are from single-center studies, with small samples and very low overall bleeding and thromboembolic complications. Periprocedural anticoagulation protocols also vary greatly between studies. Some recent meta-analysis has shown that warfarin could still be a safer and more effective alternative. There are fewer studies with rivaroxaban in AF ablation, and there have been no meta-analysis yet comparing rivaroxaban to warfarin or dabigatran. There seems to be no significant differences in safety or efficacy of rivaroxaban compared to warfarin. Interestingly, there are no available data for apixaban in AF ablation yet.
  
  
  CONCLUSIONS
  There are no consensus guidelines regarding the use of NOACs during AF ablation. Dabigatran and rivaroxaban seem as safe and effective as warfarin, although larger studies with standardized protocols are needed, as available studies may be underpowered to detect small differences in bleeding and thromboembolic rates.
authors.affiliation: Department of Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY, USA.
authors.forename: Martin
authors.initials: M
authors.lastname: Zak
authors.affiliation: Department of Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY, USA.
authors.forename: Saramaria Afanador
authors.initials: SA
authors.lastname: Castiblanco
authors.affiliation: Department of Medicine, Division of Cardiology, Lehigh Valley Health Network, Allentown, PA, USA garg.jalaj@yahoo.com.
authors.forename: Jalaj
authors.initials: J
authors.lastname: Garg
authors.affiliation: Department of Medicine, Division of Cardiology, Icahn School of Medicine, Mount Sinai Hospital, New York, NY, USA.
authors.forename: Chandrasekar
authors.initials: C
authors.lastname: Palaniswamy
authors.affiliation: Department of Medicine, Division of Cardiology, Lehigh Valley Health Network, Allentown, PA, USA.
authors.forename: Larry E
authors.initials: LE
authors.lastname: Jacobs
mesh_terms: D000284:Administration, Oral; D000925:Anticoagulants / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000628:therapy*; D006328:Cardiac Catheterization / Q000379:methods*; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods*; D000069604:Dabigatran / Q000627:therapeutic use; D065427:Factor Xa Inhibitors / Q000627:therapeutic use; D006801:Humans; D015201:Meta-Analysis as Topic; D000069552:Rivaroxaban / Q000627:therapeutic use; D013923:Thromboembolism / Q000517:prevention & control*; D016896:Treatment Outcome; D014859:Warfarin / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D065427:Factor Xa Inhibitors; D014859:Warfarin; D000069552:Rivaroxaban; D000069604:Dabigatran
keywords: anticoagulation; apixaban; atrial fibrillation ablation; dabigatran; rivaroxaban