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- Title
Anticoagulation after catheter ablation of atrial fibrillation: An unnecessary evil? A systematic review and meta‐analysis.
- Authors
Proietti, Riccardo; AlTurki, Ahmed; Di Biase, Luigi; Forleo, Giovanni; Natale, Andrea; China, Paolo; Corrado, Andrea; Marras, Elena; Themistoclakis, Sakis
- Abstract
Background: Anticoagulation in patients with atrial fibrillation (AF) is currently based on clinical parameters (CHA2DS 2‐VASc score) that have been shown to predict cerebrovascular events (CVE). Controversy exists as to whether CVE risk persists unmodified after successful catheter ablation, as observational studies suggest a lower risk of CVE. Current guidelines recommend continued oral anticoagulation (OAC) based on the CHA 2DS 2‐VASc score risk profile. Methods: We conducted a systematic literature review of all studies published up to July 31, 2018, that reported CVE after catheter ablation of AF and compared patients on or off OAC. Random‐effects models were used to demonstrate the risk of CVE and major bleeding in on‐OAC vs off‐OAC patients. This analysis was further stratified by CHADS2 and CHA 2DS 2‐VASc score. Results: We retained 16 studies, 10 prospective cohort and 6 retrospective cohort, that met inclusion criteria, and which enrolled 25 177 patients: 13 166 off‐OAC and 12 011 on‐OAC. No significant difference in the incidence of CVE emerged between on‐OAC and off‐OAC patients after AF ablation (risk ratio, 0.66; confidence interval [CI], 0.38, 1.15). Similar results were found after stratification by CHADS2 and CHA 2DS 2‐VASc score. Off‐OAC patients suffered significantly less bleeding than those on OAC (RR, 0.17; CI, 0.09, 0.34). Of note, the percentage of patients with AF recurrence impacts the treatment effect in the two groups (P = 0.001). Conclusions: In this metanalysis, the risk‐benefit ratio favored the suspension of OAT after successful AF ablation even in patients at moderate‐high risk. Whether the reported results can be extended also to non‐vitamin K antagonist oral anticoagulants warrants further investigations.
- Subjects
ATRIAL fibrillation treatment; STROKE risk factors; STROKE prevention; ANTICOAGULANTS; ATRIAL fibrillation; CATHETER ablation; HEMORRHAGE; META-analysis; RISK assessment; SYSTEMATIC reviews; DISEASE relapse; TREATMENT effectiveness; DISEASE incidence; DISEASE complications
- Publication
Journal of Cardiovascular Electrophysiology, 2019, Vol 30, Issue 4, p468
- ISSN
1045-3873
- Publication type
Article
- DOI
10.1111/jce.13822