{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,23]],"date-time":"2026-03-23T22:58:42Z","timestamp":1774306722328,"version":"3.50.1"},"reference-count":50,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2018,7,30]],"date-time":"2018-07-30T00:00:00Z","timestamp":1532908800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cardiovascular Therapeutics"],"published-print":{"date-parts":[[2018,10]]},"abstract":"Summary<\/jats:title>Aims<\/jats:title>Catheter ablation for atrial fibrillation (AF<\/jats:styled-content>) is associated with a transitory increase in the risk of both thromboembolic and bleeding events. Evidence on the use of nonvitamin K antagonist oral anticoagulants (NOAC<\/jats:styled-content>s) in patients undergoing AF<\/jats:styled-content> ablation mostly comes from small observational studies, underpowered to detect differences in clinical outcomes between NOAC<\/jats:styled-content>s and vitamin K antagonists (VKAs) treated patients. This updated meta\u2010analysis aimed to determine the safety and efficacy of periprocedural anticoagulation with NOAC<\/jats:styled-content>s compared with VKAs in AF<\/jats:styled-content> patients undergoing catheter ablation.<\/jats:p><\/jats:sec>Methods<\/jats:title>We searched MEDLINE<\/jats:styled-content>, Cochrane library, and web sources for randomized and observational studies comparing periprocedural treatment with NOAC<\/jats:styled-content>s and VKA<\/jats:styled-content>s in patients undergoing AF<\/jats:styled-content> ablation. The primary safety endpoint was major bleeding events, and the primary efficacy endpoint was thromboembolic events (a composite of systemic thromboembolism, transient ischemic attack, and stroke).<\/jats:p><\/jats:sec>Results<\/jats:title>A total of 29 studies with 12\u00a0644 patients were included in the meta\u2010analysis. Overall, patients on NOAC<\/jats:styled-content>s had a significantly lower risk of major bleeding compared to VKA<\/jats:styled-content>s either in observational studies (Peto OR<\/jats:styled-content> 0.68; 95% CI<\/jats:styled-content>: 0.48\u20100.95; P<\/jats:italic>\u00a0=\u00a00.022; I<\/jats:italic>2<\/jats:sup>\u00a0=\u00a020%) or in RCT<\/jats:styled-content>s (Peto OR<\/jats:styled-content> 0.30; 95% CI<\/jats:styled-content>: 0.14\u20100.62; P<\/jats:italic>\u00a0=\u00a00.001; I<\/jats:italic>2<\/jats:sup>\u00a0=\u00a028%). Uninterrupted NOAC<\/jats:styled-content>s reduced the risk of major bleeding when compared to uninterrupted VKA<\/jats:styled-content>s (Peto OR<\/jats:styled-content> 0.66; 95% CI<\/jats:styled-content>: 0.45\u20100.96; P<\/jats:italic>\u00a0=\u00a00.028; I<\/jats:italic>2<\/jats:sup>\u00a0=\u00a01%), similarly, interrupted NOAC<\/jats:styled-content>s lowered the risk of major bleeding compared to interrupted VKA<\/jats:styled-content>s (Peto OR<\/jats:styled-content> 0.29; 95% CI<\/jats:styled-content>: 0.13\u20100.66; P<\/jats:italic>\u00a0=\u00a00.003; I<\/jats:italic>2<\/jats:sup>\u00a0=\u00a00%; P<\/jats:italic>interaction<\/jats:sub>\u00a0=\u00a00.076). The rate of thromboembolic complications was very low and did not significantly differ between the study groups either in observational studies (Peto OR<\/jats:styled-content> 0.91; 95% CI<\/jats:styled-content>: 0.49\u20101.67; P<\/jats:italic>\u00a0=\u00a00.755; I<\/jats:italic>2<\/jats:sup>\u00a0=\u00a00%) or in RCT<\/jats:styled-content>s (Peto OR<\/jats:styled-content> 0.14; 95% CI<\/jats:styled-content>: 0.01\u20101.30; P<\/jats:italic>\u00a0=\u00a00.083; I<\/jats:italic>2<\/jats:sup>\u00a0=\u00a00%).<\/jats:p><\/jats:sec>Conclusions<\/jats:title>Use of NOAC<\/jats:styled-content>s compared to VKA<\/jats:styled-content>s significantly reduced the risk of bleeding in patients with AF<\/jats:styled-content> ablation. Similarly, the risk of bleeding was lower with uninterrupted NOAC<\/jats:styled-content>s than with uninterrupted VKA<\/jats:styled-content>s, and with interrupted NOAC<\/jats:styled-content>s than with interrupted VKA<\/jats:styled-content>s. The rate of thromboembolic complications was extremely low in both study groups without any differences.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1755-5922.12457","type":"journal-article","created":{"date-parts":[[2018,7,4]],"date-time":"2018-07-04T06:53:32Z","timestamp":1530687212000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Safety and efficacy of nonvitamin K antagonist oral anticoagulants during catheter ablation of atrial fibrillation: A systematic review and meta\u2010analysis"],"prefix":"10.1111","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0423-3664","authenticated-orcid":false,"given":"Zhen","family":"Ge","sequence":"first","affiliation":[{"name":"Icahn School of Medicine at Mount Sinai Zena and Michael A. Wiener Cardiovascular Institute New York New York"},{"name":"Division of cardiology Nanjing First Hospital Nanjing Medical University Nanjing China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michela","family":"Faggioni","sequence":"additional","affiliation":[{"name":"Icahn School of Medicine at Mount Sinai Zena and Michael A. Wiener Cardiovascular Institute New York New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Usman","family":"Baber","sequence":"additional","affiliation":[{"name":"Icahn School of Medicine at Mount Sinai Zena and Michael A. Wiener Cardiovascular Institute New York New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Samantha","family":"Sartori","sequence":"additional","affiliation":[{"name":"Icahn School of Medicine at Mount Sinai Zena and Michael A. Wiener Cardiovascular Institute New York New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sabato","family":"Sorrentino","sequence":"additional","affiliation":[{"name":"Icahn School of Medicine at Mount Sinai Zena and Michael A. Wiener Cardiovascular Institute New York New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Serdar","family":"Farhan","sequence":"additional","affiliation":[{"name":"Icahn School of Medicine at Mount Sinai Zena and Michael A. Wiener Cardiovascular Institute New York New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jaya","family":"Chandrasekhar","sequence":"additional","affiliation":[{"name":"Icahn School of Medicine at Mount Sinai Zena and Michael A. Wiener Cardiovascular Institute New York New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Birgit","family":"Vogel","sequence":"additional","affiliation":[{"name":"Icahn School of Medicine at Mount Sinai Zena and Michael A. Wiener Cardiovascular Institute New York New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abdul","family":"Qadeer","sequence":"additional","affiliation":[{"name":"Icahn School of Medicine at Mount Sinai Zena and Michael A. Wiener Cardiovascular Institute New York New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathan","family":"Halperin","sequence":"additional","affiliation":[{"name":"Icahn School of Medicine at Mount Sinai Zena and Michael A. Wiener Cardiovascular Institute New York New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vivek","family":"Reddy","sequence":"additional","affiliation":[{"name":"Icahn School of Medicine at Mount Sinai Zena and Michael A. 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