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Journal of Interventional Cardiac Electrophysiology
Published in: Journal of Interventional Cardiac Electrophysiology 3/2016

01-09-2016 | MULTIMEDIA REPORT

Network meta-analysis of efficacy and safety of competitive oral anticoagulants in patients undergoing radiofrequency catheter ablation of atrial fibrillation

Authors: Pei-Jun Li, Jun Xiao, Qing Yang, Yuan Feng, Ting Wang, Guan-Jian Liu, Zong-An Liang

Published in: Journal of Interventional Cardiac Electrophysiology | Issue 3/2016

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Abstract

Purpose

The aim of this network meta-analysis was to evaluate the comparative efficacy and safety of dabigatran, rivaroxaban, apixaban, interrupted vitamin K antagonist (I-VKA), and continuous VKA (C-VKA) in patients undergoing radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF).

Methods

PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials were searched to identify clinical trials comparing dabigatran, rivaroxaban, or apixaban with I-VKA or C-VKA, or against each other, in AF patients undergoing RFCA. A network meta-analysis was conducted to directly and indirectly compare the efficacy and safety of competitive anticoagulation regimens with a Bayesian random-effects model.

Results

A total of 39 studies enrolling 27,766 patients were included. C-VKA demonstrated significant superiority over I-VKA in reducing thromboembolic events (risk difference [RD] −0.0068, 95 % confidence interval [CI] −0.0106 to −0.0032) and major bleeding complications (RD −0.0044, 95 % CI −0.0098 to −0.0006). Rivaroxaban compared with I-VKA was associated with a lower risk of thromboembolism (RD −0.0073, 95 % CI −0.0134 to −0.0012), being at the best ranking position among all of the compared anticoagulation regimens in terms of both the efficacy and safety. None of the remaining comparisons reached statistically significant difference in the rate of thromboembolism or major bleeding.

Conclusions

The present study suggests that C-VKA is superior to I-VKA for AF patients undergoing RFCA. Rivaroxaban is the highest probability to be the optimal alternative to C-VKA among the three non-VKA oral anticoagulants in AF ablation.
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Metadata
Title
Network meta-analysis of efficacy and safety of competitive oral anticoagulants in patients undergoing radiofrequency catheter ablation of atrial fibrillation
Authors
Pei-Jun Li
Jun Xiao
Qing Yang
Yuan Feng
Ting Wang
Guan-Jian Liu
Zong-An Liang
Publication date
01-09-2016
Publisher
Springer US
Published in
Journal of Interventional Cardiac Electrophysiology / Issue 3/2016
Print ISSN: 1383-875X
Electronic ISSN: 1572-8595
DOI
https://doi.org/10.1007/s10840-016-0126-5

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