Meta-analysis of risk of stroke and thrombo-embolism with rivaroxaban versus vitamin K antagonists in ablation and cardioversion of atrial fibrillation

Ramez Nairooza, Partha Sardar, Maria Pino, Wilbert S. Aronow, Asif A. Sewani, Debabrata Mukherjee, Hakan Paydak, Waddah Maskoun

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Background: Anticoagulation in cardioversion and ablation of atrial fibrillation is imperative for reducing thrombo-embolic events. Ample information is available about the use of warfarin and vitamin K antagonists (VKA) but few trials examine safety and efficacy of rivaroxaban in these procedures. We aim to explore the hypothesis that rivaroxaban causes equal thrombo-embolic and bleeding events when used in atrial fibrillation patients undergoing ablation or cardioversion compared to VKA. Methods: We searched the online databases as well as conference abstracts till December 2014 for studies comparing rivaroxaban with VKA in atrial fibrillation patients undergoing catheter ablation or cardioversion. We report events as Odds ratio using random effects model except when event rates were less than 1% we used Peto Odds Ratio. Results: A total of 8872 atrial fibrillation patients in 15 studies undergoing either catheter ablation or cardioversion were included in this analysis. There were significantly lower stroke events with rivaroxaban compared with VKA (Peto Odds Ratio (POR) 0.33, 95% confidence interval (CI) [0.11, 0.95]; P = 0.04), and significantly less thromboembolic events with rivaroxaban compared with VKA (POR 0.46, 95% CI [0.21, 0.97]; P = 0.04). Major and minor bleeding were equal with rivaroxaban versus VKA (Odds Ratio (OR) 0.92, 95% CI [0.62, 1.36]; P = 0.68) and (OR 0.81,95% CI [0.58, 1.11]; P = 0.19) respectively. Conclusion: The use of rivaroxaban in ablation and cardioversion of atrial fibrillation may be associated with decreased risk of stroke and thromboembolism with equal bleeding risk compared to VKA.

Original languageEnglish (US)
Pages (from-to)345-353
Number of pages9
JournalInternational Journal of Cardiology
Volume187
Issue number1
DOIs
StatePublished - May 6 2015
Externally publishedYes

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Electric Countershock
Vitamin K
Embolism
Atrial Fibrillation
Meta-Analysis
Stroke
Odds Ratio
Confidence Intervals
Catheter Ablation
Hemorrhage
Thromboembolism
Warfarin
Rivaroxaban
Databases
Safety

Keywords

  • Ablation
  • Anticoagulation
  • Atrial fibrillation
  • Cardioversion
  • Oral anticoagulants

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Meta-analysis of risk of stroke and thrombo-embolism with rivaroxaban versus vitamin K antagonists in ablation and cardioversion of atrial fibrillation. / Nairooza, Ramez; Sardar, Partha; Pino, Maria; Aronow, Wilbert S.; Sewani, Asif A.; Mukherjee, Debabrata; Paydak, Hakan; Maskoun, Waddah.

In: International Journal of Cardiology, Vol. 187, No. 1, 06.05.2015, p. 345-353.

Research output: Contribution to journalArticle

Nairooza, Ramez ; Sardar, Partha ; Pino, Maria ; Aronow, Wilbert S. ; Sewani, Asif A. ; Mukherjee, Debabrata ; Paydak, Hakan ; Maskoun, Waddah. / Meta-analysis of risk of stroke and thrombo-embolism with rivaroxaban versus vitamin K antagonists in ablation and cardioversion of atrial fibrillation. In: International Journal of Cardiology. 2015 ; Vol. 187, No. 1. pp. 345-353.
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AU - Nairooza, Ramez

AU - Sardar, Partha

AU - Pino, Maria

AU - Aronow, Wilbert S.

AU - Sewani, Asif A.

AU - Mukherjee, Debabrata

AU - Paydak, Hakan

AU - Maskoun, Waddah

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N2 - Background: Anticoagulation in cardioversion and ablation of atrial fibrillation is imperative for reducing thrombo-embolic events. Ample information is available about the use of warfarin and vitamin K antagonists (VKA) but few trials examine safety and efficacy of rivaroxaban in these procedures. We aim to explore the hypothesis that rivaroxaban causes equal thrombo-embolic and bleeding events when used in atrial fibrillation patients undergoing ablation or cardioversion compared to VKA. Methods: We searched the online databases as well as conference abstracts till December 2014 for studies comparing rivaroxaban with VKA in atrial fibrillation patients undergoing catheter ablation or cardioversion. We report events as Odds ratio using random effects model except when event rates were less than 1% we used Peto Odds Ratio. Results: A total of 8872 atrial fibrillation patients in 15 studies undergoing either catheter ablation or cardioversion were included in this analysis. There were significantly lower stroke events with rivaroxaban compared with VKA (Peto Odds Ratio (POR) 0.33, 95% confidence interval (CI) [0.11, 0.95]; P = 0.04), and significantly less thromboembolic events with rivaroxaban compared with VKA (POR 0.46, 95% CI [0.21, 0.97]; P = 0.04). Major and minor bleeding were equal with rivaroxaban versus VKA (Odds Ratio (OR) 0.92, 95% CI [0.62, 1.36]; P = 0.68) and (OR 0.81,95% CI [0.58, 1.11]; P = 0.19) respectively. Conclusion: The use of rivaroxaban in ablation and cardioversion of atrial fibrillation may be associated with decreased risk of stroke and thromboembolism with equal bleeding risk compared to VKA.

AB - Background: Anticoagulation in cardioversion and ablation of atrial fibrillation is imperative for reducing thrombo-embolic events. Ample information is available about the use of warfarin and vitamin K antagonists (VKA) but few trials examine safety and efficacy of rivaroxaban in these procedures. We aim to explore the hypothesis that rivaroxaban causes equal thrombo-embolic and bleeding events when used in atrial fibrillation patients undergoing ablation or cardioversion compared to VKA. Methods: We searched the online databases as well as conference abstracts till December 2014 for studies comparing rivaroxaban with VKA in atrial fibrillation patients undergoing catheter ablation or cardioversion. We report events as Odds ratio using random effects model except when event rates were less than 1% we used Peto Odds Ratio. Results: A total of 8872 atrial fibrillation patients in 15 studies undergoing either catheter ablation or cardioversion were included in this analysis. There were significantly lower stroke events with rivaroxaban compared with VKA (Peto Odds Ratio (POR) 0.33, 95% confidence interval (CI) [0.11, 0.95]; P = 0.04), and significantly less thromboembolic events with rivaroxaban compared with VKA (POR 0.46, 95% CI [0.21, 0.97]; P = 0.04). Major and minor bleeding were equal with rivaroxaban versus VKA (Odds Ratio (OR) 0.92, 95% CI [0.62, 1.36]; P = 0.68) and (OR 0.81,95% CI [0.58, 1.11]; P = 0.19) respectively. Conclusion: The use of rivaroxaban in ablation and cardioversion of atrial fibrillation may be associated with decreased risk of stroke and thromboembolism with equal bleeding risk compared to VKA.

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