Apixaban (factor Xa inhibitor) is a novel anticoagulant and may be beneficial during atrial fibrillation (AF) ablation for prevention of thromboembolic events. However, the adverse effects of periprocedural apixaban therapy have not been thoroughly evaluated. A meta-analysis was performed to evaluate the safety of apixaban for anticoagulation in AF ablation. We searched the online databases till October 2015 for studies comparing Apixaban with Vitamin K antagonists in atrial fibrillation patients undergoing catheter ablation. Primary outcome of our study was composite of thromboembolic event and bleeding (includes major and minor bleeding). A total of 1,057 atrial fibrillation patients in 3 studies undergoing catheter ablation were included in this analysis. Zero thromboembolic events were reported in the apixaban group and 1 in the VKA group with no statistical difference (OR 0.75; 95% CI 0.03-18.49). No major differences were observed for the primary outcome (OR 0.92; 95% CI 0.54-1.55), risk of overall bleeding (OR 0.94, 95% CI 0.55- 1.58), major bleeding (OR1.37; 95% CI 0.33-5.67), minor bleeding (OR 0.89; 95% CI 0.50-1.55), pericardial effusion (OR 0.50; 95% CI 0.18-1.38) and groin hematoma (OR 1.36; 95% CI 0.70-2.65). Uninterrupted apixaban administration in patients undergoing AF catheter ablation was non-inferior to VKA without increasing the risk of major and minor bleeding

Bozorgnia, Babak, MD

Chaudhary, Rahul, MD

Garg, Jalaj, MD

Krishnamoorthy, Parasuram, MD

Natale, Andrea, MD, FACC, FHRS, FESC

Shah, Neeraj, MD

PubMed

Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health Network LVHN Scholarly Works Department of Medicine Safety Of Uninterrupted Periprocedural Apixaban In Patients Undergoing Atrial Fibrillation Catheter Ablation: A Metaanalysis Of 1,057 Patients Jalaj Garg MD Lehigh Valley Health Network, jalaj.garg@lvhn.org Rahul Chaudhary MD Parasuram Krishnamoorthy MD Neeraj Shah MD Lehigh Valley Health Network, Neeraj_N.Shah@lvhn.org Babak Bozorgnia MD Lehigh Valley Health Network, Babak.Bozorgnia@lvhn.org Follow this and additional works at: https://scholarlyworks.lvhn.org/medicine  Part of the Medical Sciences Commons Published In/Presented At Garg, J., Chaudhary, R., Krishnamoorthy, P., Shah, N., & Bozorgnia, B. (2016, April 2). Safety Of Uninterrupted Periprocedural Apixaban In Patients Undergoing Atrial Fibrillation Catheter Ablation: A Metaanalysis Of 1,057 Patients. Poster presented at: American College of Cardiology, Chicago, IL. This Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by an authorized administrator. For more information, please contact LibraryServices@lvhn.org. Apixaban (factor Xa inhibitor) is a novel anticoagulant and may be beneficial during atrial fibrillation (AF) ablation for prevention of thromboembolic events. However, the adverse effects of periprocedural apixaban therapy have not been thoroughly evaluated.© 2016 Lehigh Valley Health NetworkA meta-analysis was performed to evaluate the safety of apixaban for anticoagulation in AF ablation. We searched the online databases till September 2015 for studies comparing Apixaban with Vitamin K antagonists in atrial fibrillation patients undergoing catheter ablation. Primary outcome of our study was composite of thromboembolic event and bleeding (includes major and minor bleeding). A total of 1,057 atrial fibrillation patients in 3 studies undergoing catheter ablation were included in this analysis. Zero thromboembolic events were reported in the apixaban group and 1 in the VKA group with no statistical difference (95% CI 0.03-18.49). No major differences were observed for the primary outcome (OR 0.92; 95% CI 0.54-1.55), risk of overall bleeding (OR 0.94, 95% CI 0.55- 1.58), major bleeding (OR1.37; 95% CI 0.33-5.67), minor bleeding (OR 0.89; 95% CI 0.50-1.55), pericardial effusion (OR 0.50; 95% CI 0.18-1.38) and groin hematoma (OR 1.36; 95% CI 0.70-2.65). Uninterrupted apixaban administration in patients undergoing AF catheter ablation was non-inferior to VKA without increasing the risk of major and minor bleeding. Figure 1: Forest plot of primary outcome, thromboembolic events, overall bleeding events, groin hematoma, pericardial effusion in patients undergoing ablation of atrial fibrillation with uninterrupted apixaban compared to uninterrupted vitamin K antagonist.Study or Subgroup Events Total M-H, Random, 95% CIOdds RatioApitaxaban1.1.1. Primary outcomeDi Biase et alKaess et alNagao et alSubtotal (95% CI)Total eventsHeterogeneity. Tau2 = 0.00: Chi2 = 1.26, df = 2 (P = 0.53); I2 = 0%Test fpr pvera;; effect” Z = 0.63 (P = 0.53)911525Test for subgroup differences: Chi2 = 2.99, df = 6 (P = 0.81), I2 = 0%0.01 0.1 1 10 100Favours [Apitaxaban] Favours [VKA]Events Total WeightVitamin K antagonistM-H, Random, 95% CIOdds Ratio200105105410626164820021023764724.9%49.3%25.9%100.0%1.52 [0.53, 4.36]0.83  [0.39, 1.75]0.69 [0.25, 1.94]0.92 [0.54, 1.55]Di Biase et alKaess et alNagao et alSubtotal (95% CI)Total eventsHeterogeneity. Not applicableTest for overall effect: Z = 0.18 (P = 0.86)00001.1.2. Thromboembolic event2001051054100011200210237647100.0%100.0%Not estimableNot estimable0.75 [0.03, 18.49]0.75 [0.03, 18.49]Di Biase et alKaess et alNagao et alSubtotal (95% CI)Total eventsHeterogeneity. Tau2 = 0.00; Chi2 = 1.12, df = 2 (P = 0.57); I2 = 0%Test for overall effect: Z = 0.24 (P = 0.81)9115251.1.3. Overall Bleeding200105105410626154720021023764725.0%49.5%25.6%100.0%1.52 [0.53, 4.36]0.83 [0.39, 1.75]0.74 [0.26, 2.09]0.94 [0.55, 1.58]Di Biase et alKaess et alNagao et alSubtotal (95% CI)Total eventsHeterogeneity. Tau2 = 0.00; Chi2 = 0.44, df = 2 (P = 0.80); I2 = 0%Test for overall effect: Z = 0.43 (P = 0.67)21141.1.4. Major Bleeding200105105410113520021023764734.8%26.1%39.0%100.0%2.01 [0.18, 22.35]2.01 [0.12, 32.45]0.75 [0.08, 7.30]1.37 [0.33, 5.67]1.1.5. Minor BleedingDi Biase et alKaess et alNagao et alSubtotal (95% CI)Total eventsHeterogeneity. Tau2 = 0.00; Chi2 = 0.82, df = 2 (P = 0.67); I2 = 0%Test for overall effect: Z = 0.42 (P = 0.67)710421200105105410525124220021023764723.4%52.9%23.7%100.0%1.41 [0.44, 4.53]0.78 [0.36, 1.69]0.74 [0.23, 2.36]0.89 [0.50, 1.55]1.1.6. Groin HematomaDi Biase et alKaess et alNagao et alSubtotal (95% CI)Total eventsHeterogeneity. Tau2 = 0.00; Chi2 = 0.43, df = 2 (P = 0.81); I2 = 0%Test for overall effect: Z = 0.91 (P = 0.37)38516200105105410210112320021023764713.8%48.3%38.0%100.0%1.51 [0.25, 9.12]1.65 [0.63, 4.31]1.03 [0.35, 3.03]1.36 [0.70, 2.65]1.1.7. Pericardial EffusionDi Biase et alKaess et alNagao et alSubtotal (95% CI)Total eventsHeterogeneity. Tau2 = 0.04; Chi2 = 2.09, df = 2 (P = 0.35); I2 = 4%Test for overall effect: Z = 1.33 (P = 0.18)330620010510541021742320021023764729.7%58.7%11.6%100.0%1.51 [0.25, 9.12]0.33 [0.10, 1.17]0.25 [0.01, 4.61]0.50 [0.18, 1.38]1Lehigh Valley Health Network, Allentown, PA, 2Sinai Hospital of Baltimore, Johns Hopkins University, Baltimore, MD, 3Einstein Healthcare Network, PhiladelphiaSafety Of Uninterrupted Periprocedural Apixaban In Patients Undergoing Atrial Fibrillation Catheter Ablation: A Metaanalysis Of 1,057 Patients Jalaj Garg1, Rahul Chaudhary2, Parasuram Krishnamoorthy3, Neeraj Shah1, Babak Bozorgnia1BackgroundMethodsConclusionResults

English

Safety Of Uninterrupted Periprocedural Apixaban In Patients Undergoing Atrial Fibrillation Catheter Ablation: A Metaanalysis Of 1,057 Patients

Lehigh Valley Health Network LVHN Scholarly Works Department of Medicine Safety And Efficacy Of Uninterrupted Periprocedural Apixaban In Patients Undergoing Atrial Fibrillation Catheter Ablation: A Metaanalysis Of 1,057 Patients. Jalaj Garg MD Lehigh Valley Health Network, jalaj.garg@lvhn.org Rahul Chaudhary MD Parasuram Krishnamoorthy MD Neeraj Shah MD Lehigh Valley Health Network, Neeraj_N.Shah@lvhn.org Babak Bozorgnia MD Lehigh Valley Health Network, Babak.Bozorgnia@lvhn.org See next page for additional authors Follow this and additional works at: https://scholarlyworks.lvhn.org/medicine  Part of the Cardiology Commons, and the Medical Sciences Commons Published In/Presented At Garg, J., Chaudhary, R., Krishnamoorthy, P., Shah, N., Bozorgnia, B., & Natale, A. (2016). Safety And Efficacy Of Uninterrupted Periprocedural Apixaban In Patients Undergoing Atrial Fibrillation Catheter Ablation: A Metaanalysis Of 1,057 Patients. Journal of Atrial Fibrillation, 8(6), 1368. doi: 10.4022/jafib.1368. This Article is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by an authorized administrator. For more information, please contact LibraryServices@lvhn.org. Authors Jalaj Garg MD; Rahul Chaudhary MD; Parasuram Krishnamoorthy MD; Neeraj Shah MD; Babak Bozorgnia MD; and Andrea Natale MD, FACC, FHRS, FESC This article is available at LVHN Scholarly Works: https://scholarlyworks.lvhn.org/medicine/1364 Safety And Efficacy Of Uninterrupted Periprocedural Apixaban In Patients Undergoing Atrial Fibrillation Catheter Ablation: A Metaanalysis Of 1,057 PatientsJalaj Garg MD FESC1, Rahul Chaudhary MD2, Parasuram Krishnamoorthy MD3, Neeraj Shah MD1, Babak Bozorgnia MD1, Andrea Natale MD41Division of Cardiology, Lehigh Valley Health Network, Allentown, PA. 2Department of Medicine, Sinai Hospital of Baltimore, Johns Hopkins University, Baltimore, MD. 3Department of Medicine, Division of Cardiology, Einstein Healthcare Network, Philadelphia, PA. 4Texas Cardiac Arrhythmia Institute at St. David’s Medical Center, Austin, TX. Disclosures:None.Corresponding Author:Jalaj Garg, Division of CardiologyLehigh Valley Health Network1250 S Cedar Crest Blvd Allentown, PA 18103.Key Words: Apixaban, Atrial Fibrillation Ablation, Anticoagulation, Complica-tions.IntroductionAtrial fibrillation (AF) catheter ablation has been given a Class I recommendation (2012 AHA/ACC guidelines), for patients with symptomatic paroxysmal atrial fibrillation who are intolerant or refractory to at least one antiarrhythmic agent.1  Traditionally, patients undergoing catheter ablation for AF had anticoagulation (Vitamin K antagonist [VKA] e.g. warfarin) discontinued 3 to 5 days prior to the procedure and were bridged with heparin or a low molecular weight heparin after the procedure until the patients were therapeutically anticoagulated with warfarin.  However, there has been an increasing trend of the uninterrupted anticoagulation with VKA in patients undergoing AF ablation.  In a recent meta-analysis, Nairooz et al 2 evaluated the role of uninterrupted VKA versus interrupted VKA with heparin bridging in AF ablation. They included 13 studies (1 randomized and 12 observational) with 17, 434 patients undergoing AF ablation, of which 7877 patients managed with uninterrupted approach and 9557 with interrupted approach. There was a significantly lower incidence of major bleeding (OR 0.72, 95% CI 0.54-0.95; p=0.02), minor bleeding (OR 0.33, 95% CI 0.21-0.52; p<0.0001), combined stroke and transient ischemic attack (OR 0.25, 95% CI 0.10-0.62; p=0.003) with uninterrupted VKA as opposed to an interrupted VKA and bridging heparin/enoxaparin strategy.  Similarly, with advent of newer oral anticoagulant (NOAC’s)(especially dabigatran, rivaroxaban and apixaban, numerous studies have demonstrated thromboembolic safety profile in patients not only with non-valvular AF but also undergoing AF ablation with lower bleeding rates.  In light of these findings, 3 studies have been conducted so far (1 retrospective and 2 prospective) assessing the safety and efficacy of uninterrupted apixaban in patients undergoing AF ablation as compared to VKA.3-5  In view of these studies, we aim to perform a meta-analysis to assess for safety uninterrupted www.jafib.com Apr-May 2016| Volume 8| Issue 6AbstractApixaban (factor Xa inhibitor) is a novel anticoagulant and may be beneficial during atrial fibrillation (AF) ablation for prevention of thromboembolic events. However, the adverse effects of periprocedural apixaban therapy have not been thoroughly evaluated.  A meta-analysis was performed to evaluate the safety of apixaban for anticoagulation in AF ablation.  We searched the online databases till October 2015 for studies comparing Apixaban with Vitamin K antagonists in atrial fibrillation patients undergoing catheter ablation.  Primary outcome of our study was composite of thromboembolic event and bleeding (includes major and minor bleeding).  A total of 1,057 atrial fibrillation patients in 3 studies undergoing catheter ablation were included in this analysis.  Zero thromboembolic events were reported in the apixaban group and 1 in the VKA group with no statistical difference (OR 0.75; 95% CI 0.03-18.49).  No major differences were observed for the primary outcome (OR 0.92; 95% CI 0.54-1.55), risk of overall bleeding (OR 0.94, 95% CI 0.55- 1.58), major bleeding (OR1.37; 95% CI 0.33-5.67), minor bleeding (OR 0.89; 95% CI 0.50-1.55), pericardial effusion (OR 0.50; 95% CI 0.18-1.38) and groin hematoma (OR 1.36; 95% CI 0.70-2.65).  Uninterrupted apixaban administration in patients undergoing AF catheter ablation was non-inferior to VKA without increasing the risk of major and minor bleeding.www.jafib.com Apr-May 2016| Volume 8| Issue 6Featured ReviewJournal of Atrial FibrillationJ r l f tri l i rill ti67 t r  iperiprocedural apixaban in patients undergoing AF ablation.We searched PubMed, The Cochrane Library, EMBASE, EBSCO, Web of Science and CINAHL databases from the inception through October 15, 2015 comparing uninterrupted apixaban with uninterrupted VKA peri AF ablation.  All endpoints were reported through the longest follow up available.  The primary safety outcome in our study was a composite of thromboembolic event and overall bleeding.  Individual outcomes assessed in our study were thromboembolic event, overall bleeding, major and minor bleeding, groin hematomas and pericardial effusion.  Random effects model was followed to estimate the odds ratios (OR) and respective 95% confidence intervals (CI) using Cochrane Collaborative software, RevMan 5.3.  Measure of heterogeneity between the studies was assessed using the chi square test and was considered significant if p values < 0.10 or I2 > 50%.Three trials (2 prospective, 1 retrospective) with a total of 1,057 patients were included in the analysis, of those 410 on uninterrupted apixaban versus 647 uninterrupted VKA.  Characteristics of included studies and periprocedural anticoagulation strategy are described in table 1.  Zero thromboembolic events were reported in the apixaban group versus 1 in the VKA group with no statistical difference (OR 0.75; 95% CI 0.03-18.49).  No statistical significant difference in the primary outcome (OR 0.92; 95% CI 0.54-1.55) was observed in our study.  Consistently, no difference was observed in risk of overall bleeding (OR 0.94, 95% CI 0.55- 1.58), major bleeding (OR1.37; 95% CI 0.33-5.67), minor bleeding (OR 0.89; 95% CI 0.50-1.55), pericardial effusion (OR 0.50; 95% CI 0.18-1.38) and groin hematoma (OR 1.36; 95% CI 0.70-2.65) in the apixaban group as compared to VKA group (figure 1).This is the first meta-analysis of the currently available literature comparing uninterrupted apixaban to uninterrupted VKA in patients undergoing AF ablation.  Among 1,047 patients who underwent AF ablation, we demonstrated that there was no difference in the primary outcome (i.e. composite of thromboembolic events and bleeding) in either group.  Although non significant there were no thromboembolic events in the apixaban group as compared one event in the VKA group.  Interestingly there was also no significant difference observed in the secondary endpoints of major bleeding, minor bleeding, pericardial effusion or groin hematoma in either strategy.  Interestingly, the periprocedural activated clotting time in VKA group was significantly higher in all 3 studies: 258±26 versus 288±34, p<0.001;5 342.1±23.1 versus 363.1±26.5, p<0.001;4 275±54 versus 313±47, p<0.001,3 apixaban and VKA groups respectively. However no difference in the bleeding events were observed in the both groups.Based on our study, apixaban was the non-inferior to uninterrupted VKA in patients undergoing AF ablation.   In a recent meta-analyses by Lu et al assessing the safety and efficacy of apixaban in patients undergoing atrial fibrillation ablation, apixaban was as effective as VKA (that corroborates with our study), but our study is essentially different from this meta-analyses as we only included trials in which apixaban was used in uninterrupted fashion, and excluded all trials where apixaban was either stopped a night before or started on post-procedure day 1 (as included in Lu et al meta-analysis).6  Also other NOAC agents that have been compared to VKA include dabigatran and rivaroxaban.  There has been conflicting data with Steinberg et al 7 and Sardar et al 8 demonstrating an increase in neurologic complications with dabigatran compared to VKA.  This is contrary to the meta-analysis conducted by Honhloser et al 9 and Providencia et al 10 who demonstrated no significant differences in the composite of neurologic and bleeding complications between the dabigatran and uninterrupted VKA groups.  Rivaroxaban has even lesser data and no meta-analysis to compare the uninterrupted Rivaroxaban against uninterrupted VKA. Given the lack of literature, a randomized controlled trial AFAXA (Apixaban During Atrial Fibrillation Catheter Ablation: Comparison to Vitamin K Antagonist Therapy; NCT02227550) will provide valuable information as the study compares fixed dose apixaban (5 mg two times a day) with uninterrupted VKA (goal INR 2.0-3.0) in AF ablation.11  The primary outcome of the study is composite of all-cause mortality, stroke (ischemic stroke, subarachnoid hemorrhage and hemorrhagic stroke), and major bleeding events with follow-up period of up to 4 months. One of the major limitations of the current meta-analysis includes reliance on retrospective and prospective and lack on any randomized controlled trials. In the trial by Kaess et al,5 irrespective of the patient’s home apixaban dose or renal function, a fixed dose of 2.5 mg was administered to apixaban group, which could potentially result in decreased bleeding events.  Despite, heterogeneity in trials design, Figure 1:Forest plot of primary outcome, thromboembolic events, overall bleeding events, groin hematoma, pericardial effusion in patients undergoing ablation of atrial fibrillation with uninterrupted apixaban compared to uninterrupted vitamin K antagonistwww.jafib.com Apr-May 2016| Volume 8| Issue 6Featured ReviewJournal of Atrial FibrillationJ r l f tri l i rill ti68 t r  istudy protocols, and baseline characteristics of study population, the test of heterogeneity was non significant.Conclusion In this meta-analysis of patients undergoing AF ablation, apixaban was safe and non-inferior to uninterrupted VKA without any increase the risk of thromboembolic event, major and minor bleeding.  Although the results from randomized controlled trials are pending, our study demonstrates that safety and efficacy of apixaban in comparison to uninterrupted VKA, and hence supports its use in AF ablation.References1. Calkins H, Kuck KH, Cappato R, Brugada J, Camm AJ, Chen SA, et al. 2012 HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design: a report of the Heart Rhythm Society (HRS) Task Force on Catheter and Surgical Ablation of Atrial Fibrillation. Developed in partnership with the European Heart Rhythm Association (EHRA), a registered branch of the European Society of Cardiology (ESC) and the European Cardiac Arrhythmia Society (ECAS); and in collaboration with the American College of Cardiology (ACC), American Heart Association (AHA), the Asia Pacific Heart Rhythm Society (APHRS), and the Society of Thoracic Surgeons (STS). Endorsed by the governing bodies of the American College of Cardiology Foundation, the American Heart Association, the European Cardiac Arrhythmia Society, the European Heart Rhythm Association, the Society of Thoracic Surgeons, the Asia Pacific Heart Rhythm Society, and the Heart Rhythm Society. Heart Rhythm. 2012;9(4):632-96 e21.2. Nairooz R, Sardar P, Payne J, Aronow WS, Paydak H. Meta-analysis of major bleeding with uninterrupted warfarin compared to interrupted warfarin and heparin bridging in ablation of atrial fibrillation. Int J Cardiol. 2015;187:426-9.3. Nagao T, Inden Y, Shimano M, Fujita M, Yanagisawa S, Kato H, et al. Efficacy and safety of apixaban in the patients undergoing the ablation of atrial fibrillation. Pacing Clin Electrophysiol. 2015;38(2):155-63.4. Di Biase L, Lakkireddy D, Trivedi C, Deneke T, Martinek M, Mohanty S, et al. Feasibility and safety of uninterrupted periprocedural apixaban administration in patients undergoing radiofrequency catheter ablation for atrial fibrillation: Results from a multicenter study. Heart Rhythm. 2015;12(6):1162-8.5. Kaess BM, Ammar S, Reents T, Dillier R, Lennerz C, Semmler V, et al. Comparison of safety of left atrial catheter ablation procedures for atrial arrhythmias under continuous anticoagulation with apixaban versus phenprocoumon. Am J Cardiol. 2015;115(1):47-51.6. Lu D, Liu Q, Wang K, Zhang Q, Shan Q. Meta-analysis of Efficacy and Safety of Apixaban in Patients Undergoing Catheter Ablation for Atrial Fibrillation. Pacing Clin Electrophysiol. 2015.7. Steinberg BA, Hasselblad V, Atwater BD, Bahnson TD, Washam JB, Alexander JH, et al. Dabigatran for periprocedural anticoagulation following radiofrequency ablation for atrial fibrillation: a meta-analysis of observational studies. J Interv Card Electrophysiol. 2013;37(3):213-21.8. Sardar P, Nairooz R, Chatterjee S, Wetterslev J, Ghosh J, Aronow WS. Meta-analysis of risk of stroke or transient ischemic attack with dabigatran for atrial fibrillation ablation. Am J Cardiol. 2014;113(7):1173-7.9. Hohnloser SH, Camm AJ. Safety and efficacy of dabigatran etexilate during catheter ablation of atrial fibrillation: a meta-analysis of the literature. Europace. 2013;15(10):1407-11.10. Providencia R, Albenque JP, Combes S, Bouzeman A, Casteigt B, Combes N, et al. Safety and efficacy of dabigatran versus warfarin in patients undergoing catheter ablation of atrial fibrillation: a systematic review and meta-analysis. Heart. 2014;100(4):324-35.11. Di Biase L, Natale A. Apixaban is dear to me, but dearer still is warfarin. Pacing Clin Electrophysiol. 2015;38(2):153-4.Table 1: Descriptive characteristics of included studiesName, year Type of study n, Study /ControlAnticoagulation protocol Follow-up periodThromboembolic complications, n (%)Bleeding events, n(%)AG VG p AG VG pDi Biase et al, 2015Prospective multicenter registry400; 200/200Apixaban 2.5 mg or 5 mg two times a day according to creatinine clearance for up to 3 weeks pre-procedurally. Patients were instructed to take their apixaban dose the morning of the procedure without any discontinuation and to take next dose the same night of the procedure.30 days post-procedure0 0 >0.99 9 (4.5%) 6 (3%) 0.43Nagao et al, 2014Retrospective case control study342; 105/237Anticoagulation was started 4 weeks before; apixaban was dosed into 2.5 mg or 5 mg two times a day based on creatinine clearance, age (2.5 mg BID for ≥ 80 yrs) and weight (2.5 mg for ≤ 60 kg).  On the procedural day, the dose of apixaban was administered in the morning and in the night as usual days in the Apixaban group.3 months post-procedure0 1 (0.4%) 0.51 5(5%) 15 (6%) 0.57Kaess et al, 2014Prospective case control study325; 105/210Anticoagulation atleast 4 weeks before the procedure; All patients received apixaban 2.5 mg in the morning of procedure followed by their usual dosage in the evening; 95% of patients in apixaban were on 5 mg BID and 5% on 2.5 BIDTill the time of discharge (2 days for majority of patients)0 0 >0.99 11 (10.5%) 26 (12.3%)0.71AG: Apixaban Group; VG = Vitamin K Antagonist Group

Safety And Efficacy Of Uninterrupted Periprocedural Apixaban In Patients Undergoing Atrial Fibrillation Catheter Ablation: A Metaanalysis Of 1,057 Patients.

Safety And Efficacy Of Uninterrupted Periprocedural Apixaban In Patients Undergoing Atrial Fibrillation Catheter Ablation: A Metaanalysis Of 1,057 Patients.

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