Elgendy AY, et al. – This study entails the comparison of safety and efficacy of uninterrupted non–vitamin K antagonist oral anticoagulants (NOAC) and uninterrupted vitamin K antagonists (VKA) for catheter ablation of atrial fibrillation (AF). Researchers found evidence for a seemingly safe and effective use of uninterrupted NOAC in AF catheter ablation, but the evidence was not of high quality.

Methods

• Researchers searched electronic databases for randomized trials (RCTs) and observational studies that compared uninterrupted NOAC versus uninterrupted VKA in catheter ablation of AF.
• Safety outcomes included major bleeding, total bleeding, minor bleeding, and cardiac tamponade.
• Efficacy outcomes were symptomatic thromboembolism, symptomatic stroke/transient ischemic attack (TIA).
• They also constructed summary estimates risk ratios (RRs) with a DerSimonian-Laird model.

Results

• This study included 13 studies (3 RCTs and 10 observational studies) with 4,878 patients.
• Researchers observed that the risk of major bleeding (RR 0.83, 95% confidence Interval [CI] 0.46 - 1.50, P=0.53), total bleeding (RR 0.90, 95% CI 0.71 - 1.15, P=0.41), minor bleeding (RR 0.98, 95% CI 0.80 - 1.21, P=0.85), cardiac tamponade (RR 0.85, 95% CI 0.43 - 1.69, P=0.65), symptomatic thromboembolism (RR 0.92, 95% CI 0.26 - 3.31, P=0.90), and symptomatic stroke/TIA (RR 1.03, 95% CI 0.29 – 3.65, P=0.97) was similar in both groups.
• Notably, the quality of evidence for both major bleeding and symptomatic thromboembolism was moderate for RCTs and very low for observational studies.