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

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• 作者：Benjamin A. Steinberg (1) (2)
  Vic Hasselblad (2)
  Brett D. Atwater (1)
  Tristram D. Bahnson (1) (2)
  Jeffrey B. Washam (3)
  John H. Alexander (2)
  James P. Daubert (1) (2)
  Jonathan P. Piccini (1) (2)
  
• 关键词：Atrial fibrillation ; Ablation ; Dabigatran ; Warfarin ; Meta ; analysis
• 刊名：Journal of Interventional Cardiac Electrophysiology
• 出版年：2013
• 出版时间：September 2013
• 年：2013
• 卷：37
• 期：3
• 页码：213-221
• 全文大小：205KB
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• 作者单位：Benjamin A. Steinberg (1) (2)
  Vic Hasselblad (2)
  Brett D. Atwater (1)
  Tristram D. Bahnson (1) (2)
  Jeffrey B. Washam (3)
  John H. Alexander (2)
  James P. Daubert (1) (2)
  Jonathan P. Piccini (1) (2)
  
  1. Duke Center for Atrial Fibrillation, Electrophysiology Section, Duke University Medical Center, Durham, NC, USA
  2. Duke Clinical Research Institute, Durham, NC, USA
  3. Duke Heart Center, Durham, NC, USA
  

文摘

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 59-4?years and inclusion of women varied (10-3?%). 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.