title: Efficacy and Safety of Non-Vitamin K Antagonist Oral Anticoagulants versus Vitamin K Antagonist Oral Anticoagulants in Patients Undergoing Radiofrequency Catheter Ablation of Atrial Fibrillation: A Meta-Analysis.
abstract: BACKGROUND
  Use of the non-vitamin K antagonist oral anticoagulants (NOACs) is endorsed by current guidelines for stroke prevention in patients with atrial fibrillation (AF). However efficacy and safety of NOACs in patients undergoing catheter ablation (RFCA) of AF has not been well established yet.
  
  
  OBJECTIVE
  To perform a meta-analysis of all studies comparing NOACs and vitamin K antagonist oral anticoagulants (VKAs) in patients undergoing RFCA.
  
  
  METHODS
  Studies were searched for in PubMed and Google Scholar databases.
  
  
  METHODS
  Studies were considered eligible if: they evaluated the clinical impact of NOACs versus VKAs; they specifically analyzed the use of anticoagulants during periprocedural phase of RFCA; they reported clinical outcome data.
  
  
  METHODS
  25 studies were selected, including 9881 cases. The summary measure used was the risk ratio (RR) with 95% confidence interval (CI). The random-effects or the fixed effect model were used to synthesize results from the selected studies.
  
  
  RESULTS
  There was no significant difference in thromboembolic complications (RR 1.39; p=0.13). Bleeding complications were significantly lower in the NOACs-treated arm as compared to VKAs (RR=0.67, p<0.001). Interestingly, a larger number of thromboembolic events was found in the VKAs-treated arm in those studies where VKAs had been interrupted during the periprocedural phase (RR=0.68; p=ns). In this same subgroup a significantly higher incidence of both minor (RR=0.54; p=0.002) and major bleeding (RR=0.41; p=0.01) events was recorded. Conversely, the incidence of thromboembolic events in the VKAs-treated arm was significantly lower in those studies with uninterrupted periprocedural anticoagulation treatment (RR=1.89; p=0.02).
  
  
  CONCLUSIONS
  As with every meta-analysis, no patients-level data were available.
  
  
  CONCLUSIONS
  The use of NOACs in patients undergoing RFCA is safe, given the lower incidence of bleedings observed with NOACs. On the other side, periprocedural interruption of VKAs and bridging with heparin is associated with a higher bleeding rate with no significant benefit on onset of thromboembolic events.
authors.affiliation: Division of Cardiology, Department of Medical and Surgical Sciences, "Magna Graecia" University, Catanzaro, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Santarpia
authors.affiliation: Division of Cardiology, Department of Medical and Surgical Sciences, "Magna Graecia" University, Catanzaro, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: De Rosa
authors.affiliation: Division of Cardiology, Department of Medical and Surgical Sciences, "Magna Graecia" University, Catanzaro, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Polimeni
authors.affiliation: Division of Cardiology, Department of Medical and Surgical Sciences, "Magna Graecia" University, Catanzaro, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Giampà
authors.affiliation: Division of Cardiology, Department of Medical and Surgical Sciences, "Magna Graecia" University, Catanzaro, Italy.
authors.forename: Mariella
authors.initials: M
authors.lastname: Micieli
authors.affiliation: Division of Cardiology, Department of Medical and Surgical Sciences, "Magna Graecia" University, Catanzaro, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Curcio
authors.affiliation: Division of Cardiology, Department of Medical and Surgical Sciences, "Magna Graecia" University, Catanzaro, Italy; URT-CNR, Department of Medicine, Consiglio Nazionale delle Ricerche, Catanzaro, Italy.
authors.forename: Ciro
authors.initials: C
authors.lastname: Indolfi
mesh_terms: D000925:Anticoagulants / Q000009:adverse effects* / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000628:therapy*; D017115:Catheter Ablation / Q000379:methods; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D015994:Incidence; D020521:Stroke; D013923:Thromboembolism / Q000188:drug therapy; D014812:Vitamin K / Q000037:antagonists & inhibitors*
chemical_list: D000925:Anticoagulants; D014812:Vitamin K