Efficacy and safety of dabigatran<i> vs. </i>rivaroxaban for perioperative anticoagulation in atrial fibrillation catheter ablation: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

FAN Heng ,  ZHANG Zhihui

Vasculocardiology Department, the Third Xiangya Hospital of Central South University, Changsha, 410013, P.R.China;

Corresponding author：

ZHANG Zhihui, Email: zhangzhihui0869@126.com

Keywords：

Dabigatran; Rivaroxaban; Atrial fibrillation; Catheter ablation; Anticoagulation; meta-analysis; Systematic review; Cohort study

DOI：

10.7507/1672-2531.201809047

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objectives To systematically evaluate the efficacy and safety of dabigatran vs. rivaroxaban for perioperative anticoagulation in the ablation of nonvalvular atrial fibrillation. Methods PubMed, EMbase, Web of Science, The Cochrane Library, WanFang Data, CNKI and VIP databases were electronically searched to collect cohort studies on the efficacy and safety of dabigatran vs. rivaroxaban for perioperative anticoagulation in the ablation of nonvalvular atrial fibrillation from inception to July 1^st, 2018. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by RevMan 5.3 and Stata 12.0 software. Results A total of 12 cohort studies involving 4 051 patients were included. The results of meta-analysis showed that: there were no differences in the rate of thromboembolic (OR=0.92, 95%CI 0.36 to 2.35, P=0.86), ischemic stroke (OR=1.15, 95%CI 0.22 to 6.07, P=0.87), major bleeding (OR=0.84, 95%CI 0.43 to 1.66, P=0.61), minor bleeding (OR=0.90, 95%CI 0.60 to 1.34, P=0.60) and pericardial tamponade (OR=1.05, 95%CI 0.45 to 2.47, P=0.90) between dabigatran and rivaroxaban groups. Conclusions Current evidence shows that the efficacy and safety of dabigatran vs. rivaroxaban for perioperative anticoagulation in the ablation of nonvalvular atrial fibrillation are similar. Due to limited quality and quantity of the included studies, more high quality studies are required to verify the above conclusion.

Citation： FAN Heng, ZHANG Zhihui. Efficacy and safety of dabigatran vs. rivaroxaban for perioperative anticoagulation in atrial fibrillation catheter ablation: a meta-analysis. Chinese Journal of Evidence-Based Medicine, 2019, 19(2): 156-164. doi: 10.7507/1672-2531.201809047 Copy

1.	Calkins H, Kuck KH, Cappato R, et al. 2012 HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design: a rep. Heart Rhythm, 2012, 9(4): 632-696.
2.	Li PJ, Xiao J, Yang Q, et al. Network meta-analysis of efficacy and safety of competitive oral anticoagulants in patients undergoing radiofrequency catheter ablation of atrial fibrillation. J Interv Card Electrophysiol, 2016, 46(3): 213-224.
3.	Calkins H, Hindricks G, Cappato R, et al. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation: executive summary. J Interv Card Electrophysiol, 2017, 50(1): 1-55.
4.	中华医学会心血管病学分会, 中华医学会心电生理和起搏分会, 中国医师协会心律学专业委员会. 非瓣膜病心房颤动患者新型口服抗凝药的应用中国专家共识. 中华心律失常学杂志, 2014, 18(5): 321-329.
5.	Rillig A, Lin T, Plesman J, et al. Apixaban, rivaroxaban, and dabigatran in patients undergoing atrial fibrillation ablation. J Cardiovasc Electrophysiol, 2016, 27(2): 147-153.
6.	Winkle RA, Mead RH, Engel G, et al. Peri-procedural interrupted oral anticoagulation for atrial fibrillation ablation: comparison of aspirin, warfarin, dabigatran, and rivaroxaban. Europace, 2014, 16(10): 1443-1449.
7.	Kochhäuser S, Khaykin Y, Beardsall J, et al. Comparison of outcomes after cardioversion or atrial fibrillation ablation in patients with differing periprocedural anticoagulation regimens. Can J Cardiol, 2014, 30(12): 1541-1546.
8.	Nagao T, Inden Y, Yanagisawa S, et al. Differences in activated clotting time among uninterrupted anticoagulants during the periprocedural period of atrial fibrillation ablation. Heart Rhythm, 2015, 12(9): 1972-1978.
9.	Stepanyan G, Badhwar N, Lee RJ, et al. Safety of new oral anticoagulants for patients undergoing atrial fibrillation ablation. J Interv Card Electrophysiol, 2014, 40(1): 33-38.
10.	Yamaji H, Murakami T, Hina K, et al. Safety and efficacy of underdosing non-vitamin K antagonist oral anticoagulants in patients undergoing catheter ablation for atrial fibrillation. J Cardiovasc Pharmacol, 2017, 69(2): 118-126.
11.	Koektuerk B, Turan CH, Yorgun H, et al. The total incidence of complications and the impact of an anticoagulation regime on adverse events after cryoballoon ablation of atrial fibrillation: a single-center study of 409 patients. Cardiovasc Ther, 2016, 34(3): 144-151.
12.	Tscholl V, Lsharaf AK, Lin T, et al. Apixaban, rivaroxaban, and dabigatran use in patients undergoing catheter ablation for atrial fibrillation using the second-generation cryoballoon. Clin Cardiol, 2017, 40(11): 1095-1099.
13.	Mugnai G, de Asmundis C, Iacopino S, et al. Comparison of the incidences of complications after second-generation cryoballoon ablation of atrial fibrillation using vitamin k antagonists versus novel oral anticoagulants. Am J Cardiol, 2017, 120(2): 223-229.
14.	Eitel C, Koch J, Sommer P, et al. Novel oral anticoagulants in a real-world cohort of patients undergoing catheter ablation of atrial fibrillation. Europace, 2013, 15(11): 1587-1593.
15.	Providência R, Marijon E, Albenque JP, et al. Rivaroxaban and dabigatran in patients undergoing catheter ablation of atrial fibrillation. Europace, 2014, 16(8): 1137-1144.
16.	陈诤, 李晓宏, 蓝荣芳, 等. 心房颤动患者导管消融围术期应用口服抗凝药安全性观察. 中华心律失常学杂志, 2017, 21(4): 280-284.
17.	Cosedis NJ, Johannessen A, Raatikainen P, et al. Radiofrequency ablation as initial therapy in paroxysmal atrial fibrillation. Europace, 2012, 368(5): 478.
18.	Tofield A. Study of ablation versus antiarrhythmic drugs in persistent atrial fibrillation study shows ablation superior to drugs for patients with persistent atrial fibrillation. Eur Heart J, 2014, 35(18): 1164-1165.
19.	Kirchhof P, Benussi S, Kotecha D, et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Europace, 2016, 18(11): 1609-1678.
20.	Connolly SJ, Ezekowitz MD, Yusuf S, et al. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med, 2009, 361(12): 1139-1151.
21.	Patel MR, Mahaffey KW, Garg J, et al. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med, 2011, 365(10): 883-891.
22.	Calkins H, Willems S, Gerstenfeld EP, et al. Uninterrupted dabigatran versus warfarin for ablation in atrial fibrillation. N Engl J Med, 2017, 376(17): 1627-1636.
23.	Cappato R, Marchlinski FE, Hohnloser SH, et al. Uninterrupted rivaroxaban vs. uninterrupted vitamin K antagonists for catheter ablation in non-valvular atrial fibrillation. Eur Heart J, 2015, 36(28): 1805-1811.
24.	黄从新, 张澍, 黄德嘉, 等. 心房颤动: 目前的认识和治疗建议 (2018). 中华心律失常学杂志, 2018, 22(4): 279-346.
25.	Doherty JU, Gluckman TJ, Hucker WJ, et al. 2017 ACC expert consensus decision pathway for periprocedural management of anticoagulation in patients with nonvalvular atrial fibrillation: a report of the American College of Cardiology Clinical Expert Consensus Document Task Force. J Am Coll Cardiol, 2017, 69(7): 871-898.
26.	倪金迪, 李响, 蔡振林. 新型口服抗凝药预防非瓣膜性心房颤动相关性脑卒中的应用进展. 中国临床神经科学, 2014, (5): 557-562.
27.	任小婵, 罗选娟, 杨欢, 等. 新型口服抗凝药的临床应用研究进展. 中华全科医学, 2018, 16(4): 615-619, 666.
28.	Sairaku A, Yoshida Y, Ando M, et al. A head-to-head comparison of periprocedural coagulability under anticoagulation with rivaroxaban versus dabigatran in patients undergoing ablation of atrial fibrillation. Clin Drug Investig, 2013, 33(11): 847-853.
29.	Hansen PS, Sanchez R, Walfridsson H. Safety of novel oral anticoagulants in catheter ablation of atrial fibrillation. Dan Med J, 2016, 63(2): A5186.
30.	Bernard M, Brabham W, Netzler P, et al. Comparison of atrial fibrillation ablation bleeding and thrombotic complications with dabigatran, rivaroxaban and warfarin. J Am Coll Cardiol, 2013, 61(10): E276.
31.	Graham DJ, Reichman ME, Wernecke M, et al. Stroke, bleeding, and mortality risks in elderly medicare beneficiaries treated with dabigatran or rivaroxaban for nonvalvular atrial fibrillation. JAMA Intern Med, 2016, 176(11): 1662-1671.
32.	Noseworthy PA, Yao X, Abraham NS, et al. Direct comparison of dabigatran, rivaroxaban, and apixaban for effectiveness and safety in nonvalvular atrial fibrillation. Chest, 2016, 150(6): 1302-1312.
33.	Bai Y, Deng H, Shantsila A, et al. Rivaroxaban versus dabigatran or warfarin in real-world studies of stroke prevention in atrial fibrillation: systematic review and meta-analysis. Stroke, 2017, 48(4): 970-976.

1. Calkins H, Kuck KH, Cappato R, et al. 2012 HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design: a rep. Heart Rhythm, 2012, 9(4): 632-696.
2. Li PJ, Xiao J, Yang Q, et al. Network meta-analysis of efficacy and safety of competitive oral anticoagulants in patients undergoing radiofrequency catheter ablation of atrial fibrillation. J Interv Card Electrophysiol, 2016, 46(3): 213-224.
3. Calkins H, Hindricks G, Cappato R, et al. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation: executive summary. J Interv Card Electrophysiol, 2017, 50(1): 1-55.
4. 中华医学会心血管病学分会, 中华医学会心电生理和起搏分会, 中国医师协会心律学专业委员会. 非瓣膜病心房颤动患者新型口服抗凝药的应用中国专家共识. 中华心律失常学杂志, 2014, 18(5): 321-329.
5. Rillig A, Lin T, Plesman J, et al. Apixaban, rivaroxaban, and dabigatran in patients undergoing atrial fibrillation ablation. J Cardiovasc Electrophysiol, 2016, 27(2): 147-153.
6. Winkle RA, Mead RH, Engel G, et al. Peri-procedural interrupted oral anticoagulation for atrial fibrillation ablation: comparison of aspirin, warfarin, dabigatran, and rivaroxaban. Europace, 2014, 16(10): 1443-1449.
7. Kochhäuser S, Khaykin Y, Beardsall J, et al. Comparison of outcomes after cardioversion or atrial fibrillation ablation in patients with differing periprocedural anticoagulation regimens. Can J Cardiol, 2014, 30(12): 1541-1546.
8. Nagao T, Inden Y, Yanagisawa S, et al. Differences in activated clotting time among uninterrupted anticoagulants during the periprocedural period of atrial fibrillation ablation. Heart Rhythm, 2015, 12(9): 1972-1978.
9. Stepanyan G, Badhwar N, Lee RJ, et al. Safety of new oral anticoagulants for patients undergoing atrial fibrillation ablation. J Interv Card Electrophysiol, 2014, 40(1): 33-38.
10. Yamaji H, Murakami T, Hina K, et al. Safety and efficacy of underdosing non-vitamin K antagonist oral anticoagulants in patients undergoing catheter ablation for atrial fibrillation. J Cardiovasc Pharmacol, 2017, 69(2): 118-126.
11. Koektuerk B, Turan CH, Yorgun H, et al. The total incidence of complications and the impact of an anticoagulation regime on adverse events after cryoballoon ablation of atrial fibrillation: a single-center study of 409 patients. Cardiovasc Ther, 2016, 34(3): 144-151.
12. Tscholl V, Lsharaf AK, Lin T, et al. Apixaban, rivaroxaban, and dabigatran use in patients undergoing catheter ablation for atrial fibrillation using the second-generation cryoballoon. Clin Cardiol, 2017, 40(11): 1095-1099.
13. Mugnai G, de Asmundis C, Iacopino S, et al. Comparison of the incidences of complications after second-generation cryoballoon ablation of atrial fibrillation using vitamin k antagonists versus novel oral anticoagulants. Am J Cardiol, 2017, 120(2): 223-229.
14. Eitel C, Koch J, Sommer P, et al. Novel oral anticoagulants in a real-world cohort of patients undergoing catheter ablation of atrial fibrillation. Europace, 2013, 15(11): 1587-1593.
15. Providência R, Marijon E, Albenque JP, et al. Rivaroxaban and dabigatran in patients undergoing catheter ablation of atrial fibrillation. Europace, 2014, 16(8): 1137-1144.
16. 陈诤, 李晓宏, 蓝荣芳, 等. 心房颤动患者导管消融围术期应用口服抗凝药安全性观察. 中华心律失常学杂志, 2017, 21(4): 280-284.
17. Cosedis NJ, Johannessen A, Raatikainen P, et al. Radiofrequency ablation as initial therapy in paroxysmal atrial fibrillation. Europace, 2012, 368(5): 478.
18. Tofield A. Study of ablation versus antiarrhythmic drugs in persistent atrial fibrillation study shows ablation superior to drugs for patients with persistent atrial fibrillation. Eur Heart J, 2014, 35(18): 1164-1165.
19. Kirchhof P, Benussi S, Kotecha D, et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Europace, 2016, 18(11): 1609-1678.
20. Connolly SJ, Ezekowitz MD, Yusuf S, et al. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med, 2009, 361(12): 1139-1151.
21. Patel MR, Mahaffey KW, Garg J, et al. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med, 2011, 365(10): 883-891.
22. Calkins H, Willems S, Gerstenfeld EP, et al. Uninterrupted dabigatran versus warfarin for ablation in atrial fibrillation. N Engl J Med, 2017, 376(17): 1627-1636.
23. Cappato R, Marchlinski FE, Hohnloser SH, et al. Uninterrupted rivaroxaban vs. uninterrupted vitamin K antagonists for catheter ablation in non-valvular atrial fibrillation. Eur Heart J, 2015, 36(28): 1805-1811.
24. 黄从新, 张澍, 黄德嘉, 等. 心房颤动: 目前的认识和治疗建议 (2018). 中华心律失常学杂志, 2018, 22(4): 279-346.
25. Doherty JU, Gluckman TJ, Hucker WJ, et al. 2017 ACC expert consensus decision pathway for periprocedural management of anticoagulation in patients with nonvalvular atrial fibrillation: a report of the American College of Cardiology Clinical Expert Consensus Document Task Force. J Am Coll Cardiol, 2017, 69(7): 871-898.
26. 倪金迪, 李响, 蔡振林. 新型口服抗凝药预防非瓣膜性心房颤动相关性脑卒中的应用进展. 中国临床神经科学, 2014, (5): 557-562.
27. 任小婵, 罗选娟, 杨欢, 等. 新型口服抗凝药的临床应用研究进展. 中华全科医学, 2018, 16(4): 615-619, 666.
28. Sairaku A, Yoshida Y, Ando M, et al. A head-to-head comparison of periprocedural coagulability under anticoagulation with rivaroxaban versus dabigatran in patients undergoing ablation of atrial fibrillation. Clin Drug Investig, 2013, 33(11): 847-853.
29. Hansen PS, Sanchez R, Walfridsson H. Safety of novel oral anticoagulants in catheter ablation of atrial fibrillation. Dan Med J, 2016, 63(2): A5186.
30. Bernard M, Brabham W, Netzler P, et al. Comparison of atrial fibrillation ablation bleeding and thrombotic complications with dabigatran, rivaroxaban and warfarin. J Am Coll Cardiol, 2013, 61(10): E276.
31. Graham DJ, Reichman ME, Wernecke M, et al. Stroke, bleeding, and mortality risks in elderly medicare beneficiaries treated with dabigatran or rivaroxaban for nonvalvular atrial fibrillation. JAMA Intern Med, 2016, 176(11): 1662-1671.
32. Noseworthy PA, Yao X, Abraham NS, et al. Direct comparison of dabigatran, rivaroxaban, and apixaban for effectiveness and safety in nonvalvular atrial fibrillation. Chest, 2016, 150(6): 1302-1312.
33. Bai Y, Deng H, Shantsila A, et al. Rivaroxaban versus dabigatran or warfarin in real-world studies of stroke prevention in atrial fibrillation: systematic review and meta-analysis. Stroke, 2017, 48(4): 970-976.

Chinese Journal of Evidence-Based Medicine

Efficacy and safety of dabigatran vs. rivaroxaban for perioperative anticoagulation in atrial fibrillation catheter ablation: a meta-analysis

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