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Apixaban for periprocedural anticoagulation during catheter ablation of atrial fibrillation

Apixaban ( Eliquis ), a direct factor Xa inhibitor approved for thromboembolic prophylaxis in patients with non-valvular atrial fibrillation, is increasingly used in patients undergoing catheter ablation of atrial fibrillation.
However, large randomized studies supporting its use in the ablation context are still lacking.
A meta-analysis has assessed the impact of Apixaban in terms of thromboembolic and bleeding events in patients undergoing atrial fibrillation ablation as compared to Warfarin ( Coumadin ).

One randomized and five nonrandomized studies were included in the analysis. Patients enrolled were 1691 patients ( 668 on Apixaban and 1023 on Warfarin ).
There was no heterogeneity in all the outcome comparisons.
No deaths were reported.

Researchers did not observe any difference between Apixaban and Warfarin with respect to thromboembolic events ( odds ratio, OR = 1.10, 95 % CI 0.24-5.16 ), major bleedings ( OR = 1.56, 95 % CI 0.59-4.13 ), cardiac tamponade ( OR=1.69, 95 % CI 0.52-5.54 ), minor bleedings ( OR=0.96, 95 % CI 0.58-1.59 ), and the composite endpoint of death, thromboembolic events, and bleedings ( OR=1.03, 95 % CI 0.65-1.64 ).

In conclusion, the rates of death, thromboembolic events, major bleedings including cardiac tamponade, and minor bleedings in patients on Apixaban undergoing atrial fibrillation ablation are very low and similar to that seen in patients treated with uninterrupted Warfarin.
Although primary driven by non-randomized studies, these results support Apixaban as periprocedural anticoagulation during atrial fibrillation ablation procedures. ( Xagena2016 )

Blandino A et al, J Interv Card Electrophysiol 2016; Epub ahead of print