Comparison of Major Bleeding Events of Uninterrupted Novel Oral Anticoagulants Versus Uninterrupted Vitamin K Antagonist During Catheter Ablation of Atrial Fibrillation: A Meta-analysis of Randomized Controlled Trials

BACKGROUND Previous meta-analyses comparing major bleeding of uninterrupted non-vitamin K antagonist oral anticoagulants (NOACs) versus uninterrupted vitamin K antagonist (VKA) during catheter ablation (CA) of atrial fibrillation (AF) had no consensus. This meta-analysis was performed to comprehensively evaluate the risk of major bleeding events of these two anticoagulant strategies. METHODS We searched online databases for randomised controlled trials that compared major bleeding events of uninterrupted NOACs and VKA during CA of AF. A fixed-effect model was used if P-value was > 0.10 and I2 was < 50%, otherwise a random- effect model was used. RESULTS Six studies including 2392 patients were included in the analysis. The incidence of major bleeding was lower in the NOACs group than in the VKA group (OR = 0.56, 95% CI = 0.34 - 0.93, I2 = 38%, p = 0.15). Subgroup analyses showed that the incidence of severe puncture site complications was lower in the NOACs group than in the VKA group (OR = 0.53, 95% CI = 0.30 - 0.96, I2 = 16%, p = 0.32). But the incidence of cardiac tamponade (OR = 0.53, 95% CI = 0.23 - 1.26, I2 = 0%, p = 0.46), intracranial (OR = 0.25, 95% CI = 0.03 - 2.23, I2 = 0%, p = 0.82) and gastrointestinal bleeding (OR = 0.98, 95% CI = 0.18 - 5.39, I2 = 0%, p = 0.43) had no statistically differences between the two groups. CONCLUSION This meta-analysis suggests that compared to uninterrupted VKA, uninterrupted NOACs are superior in major bleeding during CA of AF, but this superiority existed only in the aspect of severe puncture site complications.