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

Anene Ukaigwe, Pragya Shrestha, Paras Karmacharya, Sarah Hussain, Soraya Samii, Mario Gonzalez, Deborah Wolbrette, Gerald V. Naccarrelli

Research output: Contribution to journalReview article

6 Citations (Scopus)

Abstract

Background: 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). Methods: 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. Results: 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, I2 = 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, I2 = 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, I2 = 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, I2 = 0 %). Conclusion: 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.

Original languageEnglish (US)
Pages (from-to)223-233
Number of pages11
JournalJournal of Interventional Cardiac Electrophysiology
Volume48
Issue number2
DOIs
StatePublished - Mar 1 2017

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Catheter Ablation
Vitamin K
Atrial Fibrillation
Meta-Analysis
Safety
Therapeutics
Hemorrhage
apixaban
MEDLINE
Libraries
Stroke
Odds Ratio
Clinical Trials

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

@article{9aaa6a9cb6fa4a4f8b8dfa828b6d9678,
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",
abstract = "Background: 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). Methods: 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. Results: 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, I2 = 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, I2 = 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, I2 = 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, I2 = 0 {\%}). Conclusion: 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.",
author = "Anene Ukaigwe and Pragya Shrestha and Paras Karmacharya and Sarah Hussain and Soraya Samii and Mario Gonzalez and Deborah Wolbrette and Naccarrelli, {Gerald V.}",
year = "2017",
month = "3",
day = "1",
doi = "10.1007/s10840-016-0195-5",
language = "English (US)",
volume = "48",
pages = "223--233",
journal = "Journal of Interventional Cardiac Electrophysiology",
issn = "1383-875X",
publisher = "Springer Netherlands",
number = "2",

}

TY - JOUR

T1 - 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

AU - Ukaigwe, Anene

AU - Shrestha, Pragya

AU - Karmacharya, Paras

AU - Hussain, Sarah

AU - Samii, Soraya

AU - Gonzalez, Mario

AU - Wolbrette, Deborah

AU - Naccarrelli, Gerald V.

PY - 2017/3/1

Y1 - 2017/3/1

N2 - Background: 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). Methods: 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. Results: 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, I2 = 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, I2 = 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, I2 = 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, I2 = 0 %). Conclusion: 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.

AB - Background: 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). Methods: 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. Results: 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, I2 = 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, I2 = 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, I2 = 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, I2 = 0 %). Conclusion: 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.

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U2 - 10.1007/s10840-016-0195-5

DO - 10.1007/s10840-016-0195-5

M3 - Review article

C2 - 27771820

AN - SCOPUS:84992160261

VL - 48

SP - 223

EP - 233

JO - Journal of Interventional Cardiac Electrophysiology

JF - Journal of Interventional Cardiac Electrophysiology

SN - 1383-875X

IS - 2

ER -