{"id":"87bddcd5977f","type":"article","url":"https://hartvaat.nl/2018/10/01/ononderbroken-doac-versus-vka-bij-af-ablatie-meta-analyse/","title":"Ononderbroken DOAC versus VKA bij AF-ablatie: meta-analyse","title_en":"Uninterrupted direct oral anticoagulants vs. uninterrupted vitamin K antagonists during catheter ablation of non-valvular atrial fibrillation: a systematic review and meta-analysis of randomized controlled trials.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog"],"tags":[],"journal":"Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology","doi":"10.1093/europace/euy133","source_url":"https://doi.org/10.1093/europace/euy133","authors":["Jorge Romero","Roberto C Cerrud-Rodriguez","Juan Carlos Diaz","Gregory F Michaud","Jose Taveras","Isabella Alviz","Vito Grupposo","Luis Cerna","Ricardo Avendano","Saurabh Kumar","Paulus Kirchhof","Andrea Natale","Luigi Di Biase"],"significance":7,"published":"2018-10-01","source_date":"2018-10-01","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/doacs-overzicht/","https://hartvaat.nl/kennis/antistolling/doac-versus-vka-keuze/"],"congress":"","summary_en":"This meta-analysis comparing uninterrupted DOACs with uninterrupted VKAs during catheter ablation for AF found similar or lower rates of thromboembolic and bleeding complications with DOACs, consolidating the evidence for periprocedural DOAC use.","created":"2026-07-03T10:27:31Z","updated":"2026-07-03T13:26:45Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Meta-analyse die ononderbroken DOAC vergeleek met ononderbroken VKA bij katheterablatie voor niet-valvulair AF. Consolideert het bewijs voor periprocedureel DOAC-gebruik.","abstract_original":"AIMS: To assess the incremental benefit of uninterrupted direct oral anticoagulants (DOACs) vs. uninterrupted vitamin K antagonists (VKA) for catheter ablation (CA) of non-valvular atrial fibrillation (NVAF) on three primary outcomes: major bleeding, thrombo-embolic events, and minor bleeding. A secondary outcome was post-procedural silent cerebral infarction (SCI) as detected by brain magnetic resonance imaging. METHODS AND RESULTS: A systematic review of Medline, Cochrane, and Embase was done to find all randomized controlled trials (RCTs) in which uninterrupted DOACs were compared against uninterrupted VKA for CA of NVAF. A fixed-effect model was used, with the exception of the analysis regarding major bleeding events (I2 > 25), for which a random effects model was used. The benefit of uninterrupted DOACs over VKA was analysed from four RCTs that enrolled a total of 1716 patients (male: 71.2%) with NVAF. Of these, 1100 patients (64.1%) had paroxysmal atrial fibrillation. No significant benefit was seen in major bleeding events [risk ratio (RR) 0.54, 95% confidence interval (95% CI) 0.29-1.00; P = 0.05]. No significant differences were found in minor bleeding events (RR 1.11, 95% CI 0.82-1.52; P = 0.50), thrombo-embolic events (RR 0.74, 95% CI 0.26-2.11; P = 0.57), or post-procedural SCI (RR 1.06, 95% CI 0.74-1.53; P = 0.74). CONCLUSION: An uninterrupted DOACs strategy for CA of NVAF appears to be as safe as uninterrupted VKA without a significantly increased risk of minor or major bleeding events. There was a trend favouring DOACs in terms of major bleeding. Given their ease of use, fewer drug interactions and a similar security and effectiveness profile, DOACs should be considered first line therapy in patients undergoing CA for NVAF."}