Author + information
- Received January 2, 2018
- Revision received April 11, 2018
- Accepted April 19, 2018
- Published online June 18, 2018.
- Riccardo Gorla, MD, PhDa,b,
- Francesco Dentali, MDa,
- Matteo Crippa, MDa,
- Jacopo Marazzato, MDa,
- Matteo Nicola Dario Di Minno, MDc,
- Anna Maria Grandi, MDa and
- Roberto De Ponti, MDa,∗ ()
- aDepartment of Medicine and Surgery, University of Insubria, Varese, Italy
- bDepartment of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, Milan, Italy
- cDepartment of Translational Medical Sciences, Federico II University, Napoli, Italy
- ↵∗Address for correspondence:
Dr. Roberto De Ponti, Department of Medicine and Surgery, University of Insubria, Viale Borri, 57, 21100 Varese, Italy.
Objectives The purpose of this study was to evaluate the safety and efficacy of uninterrupted and interrupted direct oral anticoagulant (DOAC) administration in patients undergoing pulmonary vein isolation (PVI).
Background The optimal periprocedural management of DOACs in patients undergoing PVI is not well defined, and different strategies are used.
Methods A systematic search of PubMed/MEDLINE, Ovid/MEDLINE, and EMBASE was performed. Three strategies for periprocedural DOAC administration were considered: uninterrupted, mildly interrupted (<12 h), and interrupted (≥12 h). Primary endpoints were major bleeding (MB) and thromboembolic (TE) complications; pooled weighted mean incidence (WMI) was calculated using a random-effects model. A secondary endpoint was the WMI of overall bleeding (OB).
Results The analysis included 43 studies for a total of 8,362 patients. DOACs showed similar safety and efficacy in the 3 subgroups. The WMI of MB was 1.02%, 1.49%, and 1.17% for the uninterrupted, mildly interrupted, and interrupted strategy, respectively; the WMI of TE complications was 0.16%, 0.46%, and 0.49% for the uninterrupted, mildly interrupted, and interrupted strategy, respectively, with no heterogeneity. OB appeared to be higher in uninterrupted (6.33%) and mildly interrupted (8.62%) groups compared with the interrupted (3.53%), with substantial heterogeneity among studies. No interaction was found between the incidence of MB and TE complications and different DOACs.
Conclusions In patients undergoing PVI, these 3 anticoagulation strategies may have similar safety and efficacy in terms of MB and TE complications. OB appears to be higher in uninterrupted and mildly interrupted strategies compared with the interrupted strategy. No substantial differences were observed among DOACs regarding the incidence of MB and TE complications.
Dr. Dentali has received a grant and honoraria from Boehringer Ingelheim, Bayer, Pfizer, and Daiichi-Sankyo. Dr. Di Minno has received grants and honoraria from Bayer, Pfizer, Novo Nordisk, and Boehringer Ingelheim. Dr. De Ponti has received significant honoraria from Biosense Webster; has received honoraria for lectures from Biosense Webster and Biotronik; and has received educational grants from Medtronic, Biosense Webster, Abbott, Boston Scientific, and Biotronik. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
All authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received January 2, 2018.
- Revision received April 11, 2018.
- Accepted April 19, 2018.
- 2018 American College of Cardiology Foundation
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