Abstract:

Objective To comprehensively assess risks of cardiac tamponade resulting from uninterrupted novel oral anticoagulants (NOACs) versus uninterrupted warfarin during the perioperative period of catheter ablation (CA) of atrial fibrillation (AF). Methods PubMed, EMBase and Cochrane Library databases were searched for studies on cardiac tamponade during the perioperative period of CA of AF with uninterrupted NOACs and warfarin from the time of NOACs application to February 2022. The Cochrane risk of bias assessment tool and MINORS (methodological index for nonrandomized studies) were adopted to evaluate the quality of literature, and Review manager 5.3 software was applied for statistical analysis on the collected data. Results A total of 13 studies involving 7, 701 patients were included. The meta-analysis showed that the difference in the risk of cardiac tamponade resulting from uninterrupted NOACs and warfarin during the perioperative period of CA of AF was statistically significant (RR=0.79, 95%CI: 0.49-1.30, P=0.36). Subgroup analysis showed that the difference in the risk of cardiac tamponade requiring thoracotomy intervention or blood transfusion between uninterrupted NOACs and warfarin during the perioperative period of CA of AF wasn’t statistically significant (RR=0.94, 95%CI: 0.48-1.86, P>0.05). The risk of cardiac tamponade wasn’t elevated in comparisons between different types of NOACs versus warfarin (P>0.05). Conclusion Uninterrupted NOACs don’t elevate the risk of cardiac tamponade during the perioperative period of CA of AF compared with uninterrupted anticoagulation of warfarin.

Key words: atrial fibrillation, catheter ablation, novel oral anticoagulants, warfarin, uninterrupted, meta-analysis