title: Uninterrupted New Oral Anticoagulants Compared With Uninterrupted Vitamin K Antagonists in Ablation of Atrial Fibrillation: A Meta-analysis.
abstract: Use of uninterrupted vitamin K antagonists (VKAs) during ablation of atrial fibrillation is superior to bridging with heparin. Few studies evaluated the use of uninterrupted new oral anticoagulants (NOACs) during ablation of atrial fibrillation. These studies are relatively small in size and mostly underpowered to show differences in the infrequent thromboembolic complications between comparators.
  
  
  
  We performed the first meta-analysis of uninterrupted NOAC compared with uninterrupted VKA in ablation of atrial fibrillation. We searched the online databases until May 2015 and report outcomes of interest as odds ratios (ORs) using a random effects model. A total of 3544 atrial fibrillation patients in 8 studies who underwent catheter ablation were included in this analysis.
  
  
  
  Overall, stroke and/or transient ischemic attack events were of very low incidence with uninterrupted anticoagulation strategy in 6 of 3544. There were no differences in rates of stroke and/or transient ischemic attack between uninterrupted NOAC and uninterrupted VKA, 0.11% vs 0.22% (OR, 0.65; 95% confidence interval [CI], 0.14-2.96; P = 0.58), nor in major bleeding 0.9% vs 1% (OR, 0.94; 95% CI, 0.48-1.87; P = 0.87). All bleeding 6.5% vs 7.3% (OR, 0.93; 95% CI, 0.67-1.29; P = 0.65), minor bleeding 6.3% vs 7.1% (OR, 0.93; 95% CI, 0.67-1.28), and cardiac tamponade 0.6% vs 0.6% (OR, 1.0; 95% CI, 0.43-2.31; P = 1.0) were all equal with uninterrupted NOACs compared with uninterrupted VKAs. Among 3544 patients, only one death occurred in the VKA group.
  
  
  
  Use of uninterrupted NOACs in ablation appears to be as safe and efficacious as use of uninterrupted VKAs.
authors.affiliation: Division of Cardiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA. Electronic address: ramez.nairooz@gmail.com.
authors.forename: Ramez
authors.initials: R
authors.lastname: Nairooz
authors.affiliation: Department of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
authors.forename: Karam
authors.initials: K
authors.lastname: Ayoub
authors.affiliation: Division of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah, USA.
authors.forename: Partha
authors.initials: P
authors.lastname: Sardar
authors.affiliation: Division of Cardiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
authors.forename: Jason
authors.initials: J
authors.lastname: Payne
authors.affiliation: Division of Cardiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Almomani
authors.affiliation: Division of Cardiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
authors.forename: Naga Venkata
authors.initials: NV
authors.lastname: Pothineni
authors.affiliation: Division of Cardiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
authors.forename: Fnu
authors.initials: F
authors.lastname: Shailesh
authors.affiliation: Division of Cardiology, New York Medical College-Westchester Medical Center, Valhalla, New York, USA.
authors.forename: Wilbert S
authors.initials: WS
authors.lastname: Aronow
authors.affiliation: Division of Cardiology, Texas Tech University Health Sciences Center, El Paso, Texas, USA.
authors.forename: Debabrata
authors.initials: D
authors.lastname: Mukherjee
mesh_terms: D000284:Administration, Oral; D000925:Anticoagulants / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000628:therapy*; D017115:Catheter Ablation / Q000379:methods; D019317:Evidence-Based Medicine; D006801:Humans; D012307:Risk Factors; D020521:Stroke / Q000517:prevention & control; D013923:Thromboembolism / Q000517:prevention & control; D014812:Vitamin K / Q000037:antagonists & inhibitors*
chemical_list: D000925:Anticoagulants; D014812:Vitamin K