Bleeding risks with novel oral anticoagulants during catheter ablation of atrial fibrillation: a systematic review and network meta-analysis.
BACKGROUND
Comprehensive comparisons of safety (measured by bleeding risk) between multiple novel oral anticoagulants (NOACs and warfarin) in the peri-procedural period of catheter ablation (CA) for atrial fibrillation (AF) are rare.


RESULTS
MEDLINE, EMBASE, and COCHRANE LIBRARY were searched up to February 2015 by two reviewers independently. Predefined inclusion criteria identified 24 studies which were included in the analysis. Data were extracted by two researchers, and a network meta-analysis was conducted in R with R2WinBugS package, within Bayesian framework. Pooled odds ratios (OR) and 95% confidence intervals (CI) were summarized to evaluate the bleeding risks of three novel anticoagulants (dabigatran, rivaroxaban, apixaban) in AF patients undergoing catheter ablation (CA). With respect to total bleeding risk, no significant difference was observed between dabigatran, rivaroxaban, apixaban, and vitamin K antagonists (VKAs) by mixed-treatment comparison. The similar results were seen in the direct comparison. While dabigatran was associated with a lower rate of minor bleeding in comparison to VKAs (OR = 0.67 with 95%CI 0.49-0.93).


CONCLUSIONS
Risks of bleeding with dabigatran, rivaroxaban, apixaban, and VKAs were similar in peri-procedural period of CA for AF.
Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300# Guangzhou road, Nanjing, 210029, Jiangsu Province, China.
Dasheng
D
Lu
Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300# Guangzhou road, Nanjing, 210029, Jiangsu Province, China.
Qi
Q
Zhang
Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300# Guangzhou road, Nanjing, 210029, Jiangsu Province, China.
Qian
Q
Liu
Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300# Guangzhou road, Nanjing, 210029, Jiangsu Province, China.
Kai
K
Wang
Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300# Guangzhou road, Nanjing, 210029, Jiangsu Province, China.
Shengchan
S
Wang
Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300# Guangzhou road, Nanjing, 210029, Jiangsu Province, China. qjshan@njmu.edu.cn.
Qijun
Q
Shan
D000284:Administration, Oral; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D001281:Atrial Fibrillation / Q000188:drug therapy / Q000453:epidemiology* / Q000601:surgery*; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data*; D017115:Catheter Ablation / Q000706:statistics & numerical data*; D015984:Causality; D015897:Comorbidity; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013923:Thromboembolism / Q000453:epidemiology / Q000517:prevention & control
D000925:Anticoagulants
Atrial fibrillation; Bleeding risk; Catheter ablation; Novel oral anticoagulants