Safety and Efficacy of Direct Oral Anti-coagulation versus Warfarin for Atrial Fibrillation Catheter Ablation: A Meta-Analysis

Kohli, Varun

Safety and Efficacy of Direct Oral Anti-coagulation versus Warfarin for Atrial Fibrillation Catheter Ablation: A Meta-Analysis

Tuesday, May 21, 2019

Belmont Ballroom 2-3 (The Cosmopolitan of Las Vegas)

Sukhdeep Bhogal , East Tennessee State University, JOHNSON CITY, TN

Varun Kohli , East Tennessee State University, Johnson City, TN

Tarun Bhandari , East Tennessee State University, JOHNSON CITY, TN

Venugopal Bhattad , East Tennessee State University, JOHNSON CITY, TN

Muralidhar Papireddy, M.D. , ETSU/MSHA, Johnson City, TN

Timir K Paul, M.D., Ph.D., FSCAI , East Tennessee State University, Johnson City, TN

Vijay Ramu , East Tennessee State University, JOHNSON CITY, TN

Background
Atrial Fibrillation (AF) poses an increased risk for thromboembolic events during and several weeks following catheter ablation. The ideal oral anticoagulant during this procedure remains a topic of debate. This study aims to determine the safety and efficacy of Direct Oral Anti-coagulation (DOACs) vs Warfarin for AF catheter ablation.

Methods
PubMed, Clinical trials registry and the Cochran Center Register of Controlled Trials were searched through October 2018 for Randomized controlled trials (RCT). The efficacy was determined with primary outcome of ischemic events and safety with primary outcome of major hemorrhage. The odds ratio (OR) with 95% confidence interval (CI) was computed and p<0.05 was considered as a level of significance.

Results
Five RCTs met the inclusion criteria with a total of 1995 patients including 995 on DOACs and 996 on warfarin for AF catheter ablation. The use of DOACs have shown to reduce the risk of major hemorrhagic events OR 0.38; 95% CI [0.21, 0.69]; p=0.001 significantly. No significant difference is observed in ischemic events between both groups OR 0.58; 95% CI [0.20, 1.66]; p=0.31.

Conclusions
Interrupted or uninterrupted use of DOACs are safer alternatives to warfarin with significant decrease in incidence of major hemorrhage for AF catheter ablation and are equally efficacious (non-inferior to warfarin) in decreasing ischemic events.