96-12: Apixaban for periprocedural anticoagulation during catheter ablation of atrial fibrillation: a systematic review and meta-analysis Free

Aims: Catheter ablation of atrial fibrillation (AF) is associated with a not negligible risk of periprocedural complications that can be mitigated by a rigorous anticoagulation protocol. Apixaban is a direct factor Xa inhibitor that has been approved for thromboembolic prophylaxis in patients with non-valvular AF. Some nonrandomized studies have recently demonstrated feasibility of apixaban in patients undergoing AF ablation, but evidence is still lacking. We undertook the present meta-analysis to assess the safety and efficacy of apixaban in patients undergoing AF ablation as compared to warfarin.

Methods and results: MEDLINE/PubMed, Cochrane Library and references reporting AF ablation and apixaban were screened and studies included if matching inclusion and exclusion criteria. Patients enrolled were 1491, 52% with paroxysmal AF while a prior stroke/TIA was present in 5.5%. The observed I2 values showed no heterogeneity in all the outcome comparisons. No deaths were reported. We did not observe any difference between apixaban and warfarin with respect to thromboembolic events (OR = 1.12, 95% CI 0.21 to 6.01), major bleedings (OR = 1.46, 95% CI 0.53 to 4.05), cardiac tamponade (OR 1.54, 95% CI 0.43-5.53), minor bleedings (0.99, 95% CI 0.58–1.69), and the composite endpoint of death, thromboembolic events, and bleedings (OR 1.04, 95% CI 0.63–1.70).

Conclusion: The rates of death, thromboembolic events, major bleedings including cardiac tamponade, and minor bleedings in patients on apixaban undergoing AF ablation are very low and similar to that seen in patients treated with uninterrupted warfarin. These results confirm the feasibility and safety of AF ablation in patients treated with apixaban.