New Oral Anticoagulants Compared To Warfarin For Perioperative Anticoagulation In Patients Undergoing Atrial Fibrillation Catheter Ablation:A Meta-analysis

Objective:New oral anticoagulants(NOACs)have been shown to be comparable to warfarin in patients with non-valvular atrial fibrillation(NVAF).This meta-analysis was performed to evaluate the efficacy and safety of NOACs for perioperative anticoagulation of AF catheter ablation.Methods:PubMed,Embase,the Cochrane Library,CNKI,VIP,and SinoMed were searched for articles published up to August 30th,2015.The data were calculated with RevMan 5.2 using a fixed-effects model.Results:Nineteen studies with a total of 7996 patients were included in this meta-analysis.NO AC treatment was associated with fewer overall bleeding events than continuous warfarin treatment(RR=0.78,95%CI=0.64-0.95,P =0.01);similarly,there were fewer overall bleeding events with NOAC treatment than interrupted warfarin treatment(RR = 0.58,95%CI=0.44-0.77,P=0.0002).In the subgroup analyses,the incidence of overall bleeding events(RR=0.67,95%CI=0.48-0.92,P=0.01)and minor bleeding events(RR=0.56,95%CI=0.37-0.86,P=0.007)in the interrupted NOAC group was lower than that in the continuous warfarin group.NOAC treatment did not increase the risk of thromboembolic complications compared with warfarin treatment(P>0.05).Conclusions:The findings of this meta-analysis suggested that periprocedural NOAC therapy was as effective as continuous warfarin therapy for preventing thromboembolism and had a lower incidence of bleeding complications.Interrupted NOAC therapy during the periprocedural period might result in a lower incidence of bleeding complications compared with continuous NOAC therapy.