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Optimal Anticoagulant Strategy for Periprocedural Management of Atrial Fibrillation Ablation: A Systematic Review and Network Meta-Analysis
Kagimoto, Minako Yamada, Takayuki Ishii, Satoshi Asai, Masanari Asano, Shunichi Yano, Hideto Ishikawa, Toshiyuki Ishigami, Tomoaki
Kagimoto, Minako
Yamada, Takayuki
Ishii, Satoshi
Asai, Masanari
Asano, Shunichi
Yano, Hideto
Ishikawa, Toshiyuki
Ishigami, Tomoaki
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2022-03-28
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http://dx.doi.org/10.3390/jcm11071872
Abstract
This network meta-analysis was performed to rank the safety and efficacy of periprocedural anticoagulant strategies in patients undergoing atrial fibrillation ablation. MEDLINE, EMBASE, CENTRAL, and Web of Science were searched to identify randomized controlled trials comparing anticoagulant regimens in patients undergoing atrial fibrillation ablation up to July 1, 2021. The primary efficacy and safety outcomes were thromboembolic and major bleeding events, respectively, and the net clinical benefit was investigated as the primary-outcome composite. Seventeen studies were included (n = 6950). The mean age ranged from 59 to 70 years; 74% of patients were men and 55% had paroxysmal atrial fibrillation. Compared with the uninterrupted vitamin-K antagonist strategy, the odds ratios for the composite of primary safety and efficacy outcomes were 0.61 (95%CI: 0.31–1.17) with uninterrupted direct oral anticoagulants, 0.63 (95%CI: 0.26–1.54) with interrupted direct oral anticoagulants, and 8.02 (95%CI: 2.35–27.45) with interrupted vitamin-K antagonists. Uninterrupted dabigatran significantly reduced the risk of the composite of primary safety and efficacy outcomes (odds ratio, 0.21; 95%CI, 0.08–0.55). Uninterrupted direct oral anticoagulants are preferred alternatives to uninterrupted vitamin-K antagonists. Interrupted direct oral anticoagulants may be feasible as alternatives. Our results support the use of uninterrupted direct oral anticoagulants as the optimal periprocedural anticoagulant strategy for patients undergoing atrial fibrillation ablation.
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Kino, T.; Kagimoto, M.; Yamada, T.; Ishii, S.; Asai, M.; Asano, S.; Yano, H.; Ishikawa, T.; Ishigami, T. Optimal Anticoagulant Strategy for Periprocedural Management of Atrial Fibrillation Ablation: A Systematic Review and Network Meta-Analysis. J. Clin. Med. 2022, 11, 1872. https://doi.org/10.3390/jcm11071872
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Journal of Clinical Medicine (JCM), Vol. 11, Iss. 7
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