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- 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.
- Authors
Ukaigwe, Anene; Shrestha, Pragya; Karmacharya, Paras; Hussain, Sarah; Samii, Soraya; Gonzalez, Mario; Wolbrette, Deborah; Naccarrelli, Gerald; Hussain, Sarah K; Gonzalez, Mario D; Naccarrelli, Gerald V
- Abstract
<bold>Background: </bold>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).<bold>Methods: </bold>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.<bold>Results: </bold>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, I 2 = 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, I 2 = 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, I 2 = 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, I 2 = 0 %).<bold>Conclusion: </bold>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.
- Subjects
APIXABAN; META-analysis; ATRIAL fibrillation prevention; CATHETER ablation; DRUG efficacy; PREVENTION of surgical complications; THROMBOEMBOLISM prevention; FIBRINOLYTIC agents; ATRIAL fibrillation; ATTRIBUTION (Social psychology); DOSE-effect relationship in pharmacology; HEMORRHAGE; HETEROCYCLIC compounds; PYRIDINE; SURGICAL complications; THROMBOEMBOLISM; VITAMIN K; SYSTEMATIC reviews; COMORBIDITY; TREATMENT effectiveness; DISEASE prevalence; CHEMICAL inhibitors
- Publication
Journal of Interventional Cardiac Electrophysiology, 2017, Vol 48, Issue 2, p223
- ISSN
1383-875X
- Publication type
journal article
- DOI
10.1007/s10840-016-0195-5