Thromboembolism and bleeding risk in atrial fibrillation ablation with uninterrupted anticoagulation between new oral anticoagulants and vitamin K antagonists: insights from an updated meta-analysis
Cumulative reports comparing the efficacy and safety outcomes between uninterrupted NOACs and vitamin K antagonists (VKA) in AF ablation had been freshly published. This meta-analysis aimed at offering a more comprehensive evaluation between these two anticoagulants in uninterrupted strategy. We sea...
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| Veröffentlicht in: | Journal of thrombosis and thrombolysis 2020-07, Vol.50 (1), p.201-210 |
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| creator | Liu, Xiao-Hua Gao, Xiao-Fei Chen, Chao-Feng Chen, Bin Xu, Yi-Zhou |
| description | Cumulative reports comparing the efficacy and safety outcomes between uninterrupted NOACs and vitamin K antagonists (VKA) in AF ablation had been freshly published. This meta-analysis aimed at offering a more comprehensive evaluation between these two anticoagulants in uninterrupted strategy. We searched in PUBMED, EMBASE, and Cochrane Library (inception to June 10, 2019) for eligible studies. Fixed-effects model was preferred in pooled analysis if I
2
300 s. In conclusions, uninterrupted NOACs was more effective than uninterrupted VKA in reducing major bleeding and pericardial effusion risk without increasing thromboembolism risk, and the benefits of uninterrupted NOACs on major bleeding complication could be more pronounced if CHA
2
DS
2
-VASc score ≥ 2 or target ACT > 300 s. |
| doi_str_mv | 10.1007/s11239-019-01989-5 |
| format | Article |
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2
< 50%. Publication bias was also evaluated. A total of 23 studies involving 12,725 individuals were analyzed in this literature. There were no difference between uninterrupted NOACs and VKA groups in incidence of Stroke/TIA (RR 0.98, 95% CI 0.54–1.77, P = 0.93, I
2
= 0%), silent cerebral embolism (RR 1.09, 95% CI 0.82–1.43, P = 0.56, I
2
= 0%), minor bleeding complication (RR 0.97, 95% CI 0.83–1.14, P = 0.73, I
2
= 0%), cardiac tamponade (RR 0.95, 95% CI 0.63–1.42, P = 0.80, I
2
= 0%). Uninterrupted NOACs was associated with significantly lower major bleeding incidence (RR 0.67, 95% CI 0.49–0.92, P = 0.01, I
2
= 0%), pericardial effusion (RR 0.75, 95% CI 0.56–1.00, P = 0.048, I
2
= 9%). In sub-analysis, no difference was found in all sub-analyses for Stroke/TIA while significant major bleeding risk reduction in uninterrupted NOACs was identified in the subgroup of CHA
2
DS
2
-VASc score ≥ 2 and target activated clotting time (ACT) > 300 s. In conclusions, uninterrupted NOACs was more effective than uninterrupted VKA in reducing major bleeding and pericardial effusion risk without increasing thromboembolism risk, and the benefits of uninterrupted NOACs on major bleeding complication could be more pronounced if CHA
2
DS
2
-VASc score ≥ 2 or target ACT > 300 s.</description><identifier>ISSN: 0929-5305</identifier><identifier>EISSN: 1573-742X</identifier><identifier>DOI: 10.1007/s11239-019-01989-5</identifier><identifier>PMID: 31686297</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Ablation ; Antagonists ; Anticoagulants ; Anticoagulants - administration & dosage ; Anticoagulants - adverse effects ; Anticoagulants - classification ; Atrial Fibrillation - therapy ; Bleeding ; Cardiology ; Catheter Ablation - adverse effects ; Catheter Ablation - methods ; Clotting ; Effusion ; Embolism ; Fibrillation ; Hematology ; Hemorrhage - chemically induced ; Hemorrhage - prevention & control ; Humans ; Medicine ; Medicine & Public Health ; Meta-analysis ; Risk Adjustment ; Tamponade ; Thromboembolism ; Thromboembolism - etiology ; Thromboembolism - prevention & control ; Vitamin K</subject><ispartof>Journal of thrombosis and thrombolysis, 2020-07, Vol.50 (1), p.201-210</ispartof><rights>Springer Science+Business Media, LLC, part of Springer Nature 2019</rights><rights>Springer Science+Business Media, LLC, part of Springer Nature 2019.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c375t-304ccd1fe90108f7ad140be2dc19c0dbde58917fb17825b5b42259dc4ac65c153</citedby><cites>FETCH-LOGICAL-c375t-304ccd1fe90108f7ad140be2dc19c0dbde58917fb17825b5b42259dc4ac65c153</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s11239-019-01989-5$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s11239-019-01989-5$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31686297$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Liu, Xiao-Hua</creatorcontrib><creatorcontrib>Gao, Xiao-Fei</creatorcontrib><creatorcontrib>Chen, Chao-Feng</creatorcontrib><creatorcontrib>Chen, Bin</creatorcontrib><creatorcontrib>Xu, Yi-Zhou</creatorcontrib><title>Thromboembolism and bleeding risk in atrial fibrillation ablation with uninterrupted anticoagulation between new oral anticoagulants and vitamin K antagonists: insights from an updated meta-analysis</title><title>Journal of thrombosis and thrombolysis</title><addtitle>J Thromb Thrombolysis</addtitle><addtitle>J Thromb Thrombolysis</addtitle><description>Cumulative reports comparing the efficacy and safety outcomes between uninterrupted NOACs and vitamin K antagonists (VKA) in AF ablation had been freshly published. This meta-analysis aimed at offering a more comprehensive evaluation between these two anticoagulants in uninterrupted strategy. We searched in PUBMED, EMBASE, and Cochrane Library (inception to June 10, 2019) for eligible studies. Fixed-effects model was preferred in pooled analysis if I
2
< 50%. Publication bias was also evaluated. A total of 23 studies involving 12,725 individuals were analyzed in this literature. There were no difference between uninterrupted NOACs and VKA groups in incidence of Stroke/TIA (RR 0.98, 95% CI 0.54–1.77, P = 0.93, I
2
= 0%), silent cerebral embolism (RR 1.09, 95% CI 0.82–1.43, P = 0.56, I
2
= 0%), minor bleeding complication (RR 0.97, 95% CI 0.83–1.14, P = 0.73, I
2
= 0%), cardiac tamponade (RR 0.95, 95% CI 0.63–1.42, P = 0.80, I
2
= 0%). Uninterrupted NOACs was associated with significantly lower major bleeding incidence (RR 0.67, 95% CI 0.49–0.92, P = 0.01, I
2
= 0%), pericardial effusion (RR 0.75, 95% CI 0.56–1.00, P = 0.048, I
2
= 9%). In sub-analysis, no difference was found in all sub-analyses for Stroke/TIA while significant major bleeding risk reduction in uninterrupted NOACs was identified in the subgroup of CHA
2
DS
2
-VASc score ≥ 2 and target activated clotting time (ACT) > 300 s. In conclusions, uninterrupted NOACs was more effective than uninterrupted VKA in reducing major bleeding and pericardial effusion risk without increasing thromboembolism risk, and the benefits of uninterrupted NOACs on major bleeding complication could be more pronounced if CHA
2
DS
2
-VASc score ≥ 2 or target ACT > 300 s.</description><subject>Ablation</subject><subject>Antagonists</subject><subject>Anticoagulants</subject><subject>Anticoagulants - administration & dosage</subject><subject>Anticoagulants - adverse effects</subject><subject>Anticoagulants - classification</subject><subject>Atrial Fibrillation - therapy</subject><subject>Bleeding</subject><subject>Cardiology</subject><subject>Catheter Ablation - adverse effects</subject><subject>Catheter Ablation - methods</subject><subject>Clotting</subject><subject>Effusion</subject><subject>Embolism</subject><subject>Fibrillation</subject><subject>Hematology</subject><subject>Hemorrhage - chemically induced</subject><subject>Hemorrhage - prevention & control</subject><subject>Humans</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Meta-analysis</subject><subject>Risk Adjustment</subject><subject>Tamponade</subject><subject>Thromboembolism</subject><subject>Thromboembolism - etiology</subject><subject>Thromboembolism - prevention & control</subject><subject>Vitamin K</subject><issn>0929-5305</issn><issn>1573-742X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp9kcuO1DAQRS0EYpqBH2CBLLEO2E7cjtmhES8xEptBYmf5UUl7SOzGdqY1P8h34XQ3jxWLkq2qU_eWdBF6TskrSoh4nSllrWwIPVYvG_4AbSgXbSM69u0h2hDJarMl_AI9yfmWECIlYY_RRUu3_ZZJsUE_b3YpziZCrcnnGevgsJkAnA8jTj5_xz5gXZLXEx68SX6adPGx9sz5c_Blh5fgQ4GUln0BV0WKt1GPyxkxUA4AAQc44Jiq0j9AKPloeueLnqvX53Woxxh8LvlNdc9-3FVmqHfWEV72Tq8eMxTd6KCn--zzU_Ro0FOGZ-f3En19_-7m6mNz_eXDp6u3141tBS9NSzprHR1AEkr6QWhHO2KAOUulJc444L2kYjBU9IwbbjrGuHS203bLLeXtJXp50t2n-GOBXNRtXFI9IivWUSY469hKsRNlU8w5waD2yc863StK1BqdOkWnamzqGJ1al16cpRczg_uz8jurCrQnINdRGCH99f6P7C8-sash</recordid><startdate>20200701</startdate><enddate>20200701</enddate><creator>Liu, Xiao-Hua</creator><creator>Gao, Xiao-Fei</creator><creator>Chen, Chao-Feng</creator><creator>Chen, Bin</creator><creator>Xu, Yi-Zhou</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7TK</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope></search><sort><creationdate>20200701</creationdate><title>Thromboembolism and bleeding risk in atrial fibrillation ablation with uninterrupted anticoagulation between new oral anticoagulants and vitamin K antagonists: insights from an updated meta-analysis</title><author>Liu, Xiao-Hua ; 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This meta-analysis aimed at offering a more comprehensive evaluation between these two anticoagulants in uninterrupted strategy. We searched in PUBMED, EMBASE, and Cochrane Library (inception to June 10, 2019) for eligible studies. Fixed-effects model was preferred in pooled analysis if I
2
< 50%. Publication bias was also evaluated. A total of 23 studies involving 12,725 individuals were analyzed in this literature. There were no difference between uninterrupted NOACs and VKA groups in incidence of Stroke/TIA (RR 0.98, 95% CI 0.54–1.77, P = 0.93, I
2
= 0%), silent cerebral embolism (RR 1.09, 95% CI 0.82–1.43, P = 0.56, I
2
= 0%), minor bleeding complication (RR 0.97, 95% CI 0.83–1.14, P = 0.73, I
2
= 0%), cardiac tamponade (RR 0.95, 95% CI 0.63–1.42, P = 0.80, I
2
= 0%). Uninterrupted NOACs was associated with significantly lower major bleeding incidence (RR 0.67, 95% CI 0.49–0.92, P = 0.01, I
2
= 0%), pericardial effusion (RR 0.75, 95% CI 0.56–1.00, P = 0.048, I
2
= 9%). In sub-analysis, no difference was found in all sub-analyses for Stroke/TIA while significant major bleeding risk reduction in uninterrupted NOACs was identified in the subgroup of CHA
2
DS
2
-VASc score ≥ 2 and target activated clotting time (ACT) > 300 s. In conclusions, uninterrupted NOACs was more effective than uninterrupted VKA in reducing major bleeding and pericardial effusion risk without increasing thromboembolism risk, and the benefits of uninterrupted NOACs on major bleeding complication could be more pronounced if CHA
2
DS
2
-VASc score ≥ 2 or target ACT > 300 s.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>31686297</pmid><doi>10.1007/s11239-019-01989-5</doi><tpages>10</tpages></addata></record> |
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| subjects | Ablation Antagonists Anticoagulants Anticoagulants - administration & dosage Anticoagulants - adverse effects Anticoagulants - classification Atrial Fibrillation - therapy Bleeding Cardiology Catheter Ablation - adverse effects Catheter Ablation - methods Clotting Effusion Embolism Fibrillation Hematology Hemorrhage - chemically induced Hemorrhage - prevention & control Humans Medicine Medicine & Public Health Meta-analysis Risk Adjustment Tamponade Thromboembolism Thromboembolism - etiology Thromboembolism - prevention & control Vitamin K |
| title | Thromboembolism and bleeding risk in atrial fibrillation ablation with uninterrupted anticoagulation between new oral anticoagulants and vitamin K antagonists: insights from an updated meta-analysis |
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