title: Meta-analysis of efficacy and safety of apixaban and uninterrupted apixaban therapy compared to vitamin K antagonists in patients undergoing catheter ablation for atrial fibrillation.
abstract: BACKGROUND
  Apixaban is a Factor Xa inhibitor increasingly being used for stroke prevention in atrial fibrillation (AF). Although several studies have been done, the efficacy and safety of apixaban during the peri-procedural period of AF ablation remains unclear. We sought to systematically review pooled data from these various studies to evaluate thromboembolic and bleeding risks in patients undergoing catheter ablation for AF who are treated with apixaban (interrupted and uninterrupted).
  
  
  METHODS
  Studies comparing anticoagulation with apixaban or vitamin K antagonists (VKA) in patients undergoing ablation for AF were identified via an electronic search of MEDLINE, EMBASE, clinical trials.gov, and Cochrane Library from inception to January 2016. Study-specific risk ratios were calculated and combined with a fixed-effects model meta-analysis.
  
  
  RESULTS
  In the analysis of 2100 pooled patients, thromboembolic complications (TE) occurred in 14/778 (1.80 %) patients in the apixaban group (AG) compared to 20/1322 patients in the VKA group (RR 1.03, 95 % CI 0.55-1.90, p = 0.93, I2= 0 %). Major bleeding occurred in 9/778 (1.2 %) of the AG compared to 20/1322 (1.51 %) in the VKA group (RR 1.03, 95 % CI 0.55-1.90, p = 0.93, I2= 0 %). In uninterrupted apixaban group (uAG), TE occurred in 4/585 (0.68 %) patients in the uAG compared to 6/910 (0.66 %) in VKA group (RR 0.86, 95 % CI 0.25-2.95, p = 0.81, I2= 0 %). Major bleeding occurred in 5/585 (0.85 %) in uAG compared to 7/910 (0.77 %) in the VKA group (RR 1.20, 95 % CI 0.37-3.88, p = 0.76, I2= 0 %).
  
  
  CONCLUSIONS
  Our study demonstrates patients treated with apixaban and VKA during the peri-procedural period for AF ablation have similar rates of TE and bleeding complications. Interrupted and uninterrupted apixaban strategies were associated with similar outcomes.
authors: Division of Cardiology, Heart and Vascular Institute, Pennsylvania State University, Hershey Medical Center, 500 University Drive, Hershey, PA, 17033, USA. acukaigwe@gmail.com.
authors: Anene
authors: A
authors: Ukaigwe
authors: Department of Medicine, Reading Health System, West Reading, PA, USA.
authors: Pragya
authors: P
authors: Shrestha
authors: Department of Medicine, Reading Health System, West Reading, PA, USA.
authors: Paras
authors: P
authors: Karmacharya
authors: Electrophysiology Program, Division of Cardiology, Heart and Vascular Institute, Penn State University, Hershey Medical Center, Hershey, PA, USA.
authors: Sarah K
authors: SK
authors: Hussain
authors: Electrophysiology Program, Division of Cardiology, Heart and Vascular Institute, Penn State University, Hershey Medical Center, Hershey, PA, USA.
authors: Soraya
authors: S
authors: Samii
authors: Electrophysiology Program, Division of Cardiology, Heart and Vascular Institute, Penn State University, Hershey Medical Center, Hershey, PA, USA.
authors: Mario D
authors: MD
authors: Gonzalez
authors: Electrophysiology Program, Division of Cardiology, Heart and Vascular Institute, Penn State University, Hershey Medical Center, Hershey, PA, USA.
authors: Deborah
authors: D
authors: Wolbrette
authors: Electrophysiology Program, Division of Cardiology, Heart and Vascular Institute, Penn State University, Hershey Medical Center, Hershey, PA, USA.
authors: Gerald V
authors: GV
authors: Naccarrelli
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000453:epidemiology*; D017115:Catheter Ablation / Q000706:statistics & numerical data*; D015984:Causality; D015897:Comorbidity; D004305:Dose-Response Relationship, Drug; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage; D006470:Hemorrhage / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D015995:Prevalence; D011720:Pyrazoles / Q000008:administration & dosage*; D011728:Pyridones / Q000008:administration & dosage*; D012307:Risk Factors; D013923:Thromboembolism / Q000453:epidemiology* / Q000517:prevention & control*; D016896:Treatment Outcome; D014812:Vitamin K / Q000037:antagonists & inhibitors
chemical_list: D005343:Fibrinolytic Agents; D011720:Pyrazoles; D011728:Pyridones; D014812:Vitamin K; C522181:apixaban
keywords: Apixaban; Atrial fibrillation; Catheter ablation