Aims 

Uninterrupted anticoagulation is recommended during the ablation of atrial fibrillation. This meta-analysis compared the safety and efficacy of uninterrupted direct oral anticoagulants (DOACs) to uninterrupted vitamin K antagonists (VKAs) during atrial fibrillation ablation.

Methods 

The meta-analysis included eligible randomized controlled trials from 2009 to 2019. Odds ratios (ORs) and 95% confidence intervals were pooled using a random effects model and a sensitivity analysis was performed by sequentially removing one study or DOAC at a time.

Results 

Six studies were included; 1288 received DOAC and 1081 VKA. Pooled ORs indicated a lower nonsignificant incidence in DOACs vs. VKA of composite outcome of major bleeding, stroke, or transient ischemic attack, and mortality (0.69; 0.28–1.71; 31 vs. 45 events), major bleeding alone (0.66; 0.30–1.47; 27 vs. 41 events), and cardiac tamponade (0.56; 0.21–1.45; eight vs. 13 events) with a slightly higher occurrence of minor bleeding (1.17; 0.89–1.56; 139 vs. 106 events) and silent cerebral thromboembolic events (1.12; 0.75–1.66; 72 vs. 58 among 442 and 376 patients performing MRI study). Sensitivity analyses confirmed overall results: pooled ORs ranged from 0.56 to 1.00 for the composite outcome and from 0.54 to 0.92 for major bleedings.

Conclusion 

Uninterrupted DOAC is a safe and effective alternative to uninterrupted VKA during atrial fibrillation ablation.

中文翻译：

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不间断抗凝治疗房颤的导管消融：对六项随机对照试验的荟萃分析。

目的 

推荐在房颤消融期间进行不间断的抗凝治疗。这项荟萃分析比较了房颤消融期间不间断直接口服抗凝剂（DOAC）与不间断维生素K拮抗剂（VKA）的安全性和有效性。

方法 

的荟萃分析包括合格的随机对照试验从2009年到2019年的比值比（OR）和95个％置信区间采用随机效应模型和灵敏度分析合并通过在一个时间顺序地去除一个或研究进行DOAC。

结果 

包括六项研究；1288年收到DOAC和1081 VKA。合并的ORs显示，严重出血，中风或短暂性脑缺血发作和死亡的综合结局，DOAC比VKA的非显着性发生率低（0.69； 0.28–1.71； 31 vs. 45事件），仅严重出血（0.66； 0.30– 1.47； 27 vs. 41事件）和心脏压塞（0.56； 0.21–1.45； 8 vs. 13事件），轻微出血（1.17； 0.89–1.56； 139 vs. 106事件）和无症状性脑血栓栓塞的发生率略高事件（在进行MRI研究的442和376名患者中，1.12； 0.75-1.66； 72比58）。敏感性分析证实了总体结果：综合结果的合并OR范围为0.56至1.00，严重出血的OR范围为0.54至0.92。

结论 

在房颤消融过程中，不间断DOAC是不间断VKA的安全有效替代方案。