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Meta-Analysis
. 2013 Sep;37(3):213-21.
doi: 10.1007/s10840-013-9813-7. Epub 2013 Jul 24.

Dabigatran for periprocedural anticoagulation following radiofrequency ablation for atrial fibrillation: a meta-analysis of observational studies

Benjamin A Steinberg  1 , Vic Hasselblad, Brett D Atwater, Tristram D Bahnson, Jeffrey B Washam, John H Alexander, James P Daubert, Jonathan P Piccini
Affiliations
Meta-Analysis

Dabigatran for periprocedural anticoagulation following radiofrequency ablation for atrial fibrillation: a meta-analysis of observational studies

Benjamin A Steinberg et al. J Interv Card Electrophysiol. 2013 Sep.

Abstract

Purpose: Dabigatran is approved for prevention of stroke or systemic embolism in patients with nonvalvular atrial fibrillation (AF). The safety and effectiveness of periprocedural dabigatran in ablation for AF are unknown.

Methods: We performed a meta-analysis of all studies comparing periprocedural dabigatran with warfarin for anticoagulation in AF ablation. Studies of >100 patients with post-procedure follow-up were included. Outcomes were compared by calculating maximum likelihood estimates with confidence intervals. The co-primary endpoints were neurological events and major bleeding.

Results: Ten cohort studies were included, including a total of 1,501 patients receiving dabigatran and 2,356 receiving warfarin. The mean age was 59-64 years and inclusion of women varied (10-33 %). Intra-procedural unfractionated heparin and irrigated ablation catheters were used routinely. Adverse events were low overall; however, the dabigatran group demonstrated a numerical excess of neurological events (10/1,501 [0.7 %] versus 4/2,356 [0.2 %]), but equivalent major bleeding outcomes (24/1,501 [1.6 %] versus 40/2,356 [1.7 %]). In the meta-analysis, there was a nonsignificant trend towards higher rates of the composite primary endpoints (any neurological event or major bleeding) in the dabigatran group. Dabigatran demonstrated a significantly higher rate of neurological events (estimated absolute risk difference 0.0047, 95 % confidence interval 0.0007 to 0.0099).

Conclusions: Compared with warfarin, dabigatran may be associated with a higher frequency of periprocedural neurological events following radiofrequency ablation of AF. Randomized clinical trials are needed to definitively assess the safety and efficacy of novel oral anticoagulant use for periprocedural anticoagulation for ablation of AF.

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Conflict of interest statement

Conflict of interest Drs. Steinberg and Hasselblad have no relevant disclosures. A full list of Dr. Piccini and Dr. Alexander’s disclosures can be found at https://www.dcri.org/about-us/conflict-of-interest.

Figures

Fig. 1
Fig. 1
PRISMA diagram of meta-analysis to identify studies [8]. PRISMA Preferred Reporting Items for Systematic Reviews and Meta-Analyses
Fig. 2
Fig. 2
Combined rates of raw outcomes across studies, with estimated absolute risk differences and forest plot of outcomes. Composite outcome includes any major bleeding or neurological event. Reported as total numbers of events (percent) for raw outcomes
See this image and copyright information in PMC

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