Publicação
Anticoagulation after typical atrial flutter ablation: systematic review and meta‐analysis
| Resumo: | Background: Cavotricuspid isthmus (CTI) ablation in typical atrial flutter (AFL) restores sinus rhythm in 95% of patients, which may lead to the discontinuation of oral anticoagulation during follow-up. Therefore, we aimed to systematically review the clinical impact of oral anticoagulation in the incidence of thromboembolic events (TE) after typical AFL ablation. Methods: We searched for controlled studies evaluating the impact of anticoagulation in the incidence of TE in patients submitted to AFL ablation in MEDLINE, CENTRAL, PsycINFO database (June/2021). The primary outcome was TE events (ischemic stroke or systemic embolism). A meta-analysis was performed deriving risk ratios (RR) and 95% confidence intervals (CI). Statistical heterogeneity was measured through I2 metric. The confidence in the evidence was appraised with Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. Results: Eight observational studies with 4870 patients were included. TE events were not significantly reduced (RR 1.18, 95% CI 0.59-2.36; n = 4870; GRADE very low). A meta-regression showed that for each 10% increase in the prevalence of previous AF in the studied population, anticoagulation reduced TE risk in 32%. There were no significant differences regarding bleeding events (RR 2.16, 95% CI 0.43-10.97, I2 = 0%; GRADE low), but there was a lower all-cause mortality (RR 0.24, 95% CI 0.17-0.32, GRADE low). Conclusion: The best available evidence lacks robustness and the data did not definitely associate anticoagulation after typical AFL ablation with reduced TE. |
|---|---|
| Autores principais: | Ferreira, Afonso Nunes |
| Outros Autores: | Alves, Mariana; Lima Da Silva, Gustavo; Cortez-Dias, Nuno; De Sousa, João; Pinto, Fausto J.; Caldeira, Daniel |
| Assunto: | Cavotricuspid isthmus ablation Oral anticoagulation Thromboembolic events Typical atrial flutter |
| Ano: | 2021 |
| País: | Portugal |
| Tipo de documento: | artigo |
| Tipo de acesso: | acesso restrito |
| Instituição associada: | Universidade de Lisboa |
| Idioma: | inglês |
| Origem: | Repositório da Universidade de Lisboa |
| _version_ | 1865920826716454912 |
|---|---|
| author | Ferreira, Afonso Nunes |
| author2 | Alves, Mariana Lima Da Silva, Gustavo Cortez-Dias, Nuno De Sousa, João Pinto, Fausto J. Caldeira, Daniel |
| author2_role | author author author author author author |
| author_facet | Ferreira, Afonso Nunes Ferreira, Afonso Nunes Alves, Mariana Lima Da Silva, Gustavo Cortez-Dias, Nuno De Sousa, João Pinto, Fausto J. Caldeira, Daniel Alves, Mariana Lima Da Silva, Gustavo Cortez-Dias, Nuno De Sousa, João Pinto, Fausto J. Caldeira, Daniel |
| author_role | author |
| contributor_name_str_mv | Repositório Científico de Acesso Aberto da ULisboa |
| country_str | PT |
| creators_json_str | [{\"Person.name\":\"Ferreira, Afonso Nunes\",\"Person.identifier.orcid\":\"0000-0002-2836-9497\"},{\"Person.name\":\"Alves, Mariana\",\"Person.identifier.orcid\":\"0000-0002-1369-8423\"},{\"Person.name\":\"Lima Da Silva, Gustavo\",\"Person.identifier.orcid\":\"0000-0003-3138-8354\"},{\"Person.name\":\"Cortez-Dias, Nuno\",\"Person.identifier.orcid\":\"0000-0002-9244-4631\"},{\"Person.name\":\"De Sousa, João\",\"Person.identifier.orcid\":\"0000-0003-2782-8214\"},{\"Person.name\":\"Pinto, Fausto J.\",\"Person.identifier.orcid\":\"0000-0002-8034-4529\"},{\"Person.name\":\"Caldeira, Daniel\",\"Person.identifier.orcid\":\"0000-0002-2520-5673\"}] |
| datacite.contributors.contributor.contributorName.fl_str_mv | Repositório Científico de Acesso Aberto da ULisboa |
| datacite.creators.creator.creatorName.fl_str_mv | Ferreira, Afonso Nunes Alves, Mariana Lima Da Silva, Gustavo Cortez-Dias, Nuno De Sousa, João Pinto, Fausto J. Caldeira, Daniel |
| datacite.date.Accepted.fl_str_mv | 2021-01-01T00:00:00Z |
| datacite.date.available.fl_str_mv | 2021-09-17T16:07:23Z |
| datacite.date.embargoed.fl_str_mv | 2021-09-17T16:07:23Z |
| datacite.rights.fl_str_mv | http://purl.org/coar/access_right/c_16ec |
| datacite.subjects.subject.fl_str_mv | Cavotricuspid isthmus ablation Oral anticoagulation Thromboembolic events Typical atrial flutter |
| datacite.titles.title.fl_str_mv | Anticoagulation after typical atrial flutter ablation: systematic review and meta‐analysis |
| dc.contributor.none.fl_str_mv | Repositório Científico de Acesso Aberto da ULisboa |
| dc.creator.none.fl_str_mv | Ferreira, Afonso Nunes Alves, Mariana Lima Da Silva, Gustavo Cortez-Dias, Nuno De Sousa, João Pinto, Fausto J. Caldeira, Daniel |
| dc.date.Accepted.fl_str_mv | 2021-01-01T00:00:00Z |
| dc.date.available.fl_str_mv | 2021-09-17T16:07:23Z |
| dc.date.embargoed.fl_str_mv | 2021-09-17T16:07:23Z |
| dc.format.none.fl_str_mv | application/pdf |
| dc.identifier.none.fl_str_mv | http://hdl.handle.net/10451/49543 |
| dc.language.none.fl_str_mv | eng |
| dc.publisher.none.fl_str_mv | John Wiley & Sons, Inc. |
| dc.rights.none.fl_str_mv | http://purl.org/coar/access_right/c_16ec |
| dc.subject.none.fl_str_mv | Cavotricuspid isthmus ablation Oral anticoagulation Thromboembolic events Typical atrial flutter |
| dc.title.fl_str_mv | Anticoagulation after typical atrial flutter ablation: systematic review and meta‐analysis |
| dc.type.none.fl_str_mv | http://purl.org/coar/resource_type/c_6501 |
| description | Background: Cavotricuspid isthmus (CTI) ablation in typical atrial flutter (AFL) restores sinus rhythm in 95% of patients, which may lead to the discontinuation of oral anticoagulation during follow-up. Therefore, we aimed to systematically review the clinical impact of oral anticoagulation in the incidence of thromboembolic events (TE) after typical AFL ablation. Methods: We searched for controlled studies evaluating the impact of anticoagulation in the incidence of TE in patients submitted to AFL ablation in MEDLINE, CENTRAL, PsycINFO database (June/2021). The primary outcome was TE events (ischemic stroke or systemic embolism). A meta-analysis was performed deriving risk ratios (RR) and 95% confidence intervals (CI). Statistical heterogeneity was measured through I2 metric. The confidence in the evidence was appraised with Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. Results: Eight observational studies with 4870 patients were included. TE events were not significantly reduced (RR 1.18, 95% CI 0.59-2.36; n = 4870; GRADE very low). A meta-regression showed that for each 10% increase in the prevalence of previous AF in the studied population, anticoagulation reduced TE risk in 32%. There were no significant differences regarding bleeding events (RR 2.16, 95% CI 0.43-10.97, I2 = 0%; GRADE low), but there was a lower all-cause mortality (RR 0.24, 95% CI 0.17-0.32, GRADE low). Conclusion: The best available evidence lacks robustness and the data did not definitely associate anticoagulation after typical AFL ablation with reduced TE. |
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| eu_rights_str_mv | restrictedAccess |
| format | article |
| fulltext.url.fl_str_mv | https://repositorio.ulisboa.pt/bitstreams/c95abfa3-365c-43fc-be77-f4619a8a9e74/download |
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| identifier.url.fl_str_mv | http://hdl.handle.net/10451/49543 |
| instacron_str | ul |
| institution | Universidade de Lisboa |
| instname_str | Universidade de Lisboa |
| language | eng |
| network_acronym_str | ul |
| network_name_str | Repositório da Universidade de Lisboa |
| oai_identifier_str | oai:repositorio.ulisboa.pt:10451/49543 |
| organization_str_mv | urn:organizationAcronym:ul |
| person_str_mv | Ferreira, Afonso Nunes Ferreira, Afonso Nunes https://www.ciencia-id.pt/0419-C014-BA22 0419-C014-BA22 http://orcid.org/0000-0002-2836-9497 0000-0002-2836-9497 Alves, Mariana Alves, Mariana https://www.ciencia-id.pt/0718-09A9-D4EA 0718-09A9-D4EA http://orcid.org/0000-0002-1369-8423 0000-0002-1369-8423 Lima Da Silva, Gustavo Lima Da Silva, Gustavo https://www.ciencia-id.pt/FB15-EB01-5F40 FB15-EB01-5F40 http://orcid.org/0000-0003-3138-8354 0000-0003-3138-8354 Cortez-Dias, Nuno Cortez-Dias, Nuno https://www.ciencia-id.pt/D612-D3C3-6E1D D612-D3C3-6E1D http://orcid.org/0000-0002-9244-4631 0000-0002-9244-4631 De Sousa, João De Sousa, João https://www.ciencia-id.pt/7D1D-FC15-13D6 7D1D-FC15-13D6 http://orcid.org/0000-0003-2782-8214 0000-0003-2782-8214 Pinto, Fausto J. Pinto, Fausto J. https://www.ciencia-id.pt/C311-AEDD-6DBB C311-AEDD-6DBB http://orcid.org/0000-0002-8034-4529 0000-0002-8034-4529 Caldeira, Daniel Caldeira, Daniel https://www.ciencia-id.pt/AA19-EC35-8D01 AA19-EC35-8D01 http://orcid.org/0000-0002-2520-5673 0000-0002-2520-5673 |
| publishDate | 2021 |
| publisher.none.fl_str_mv | John Wiley & Sons, Inc. |
| reponame_str | Repositório da Universidade de Lisboa |
| repository_id_str | urn:repositoryAcronym:ul |
| service_str_mv | urn:repositoryAcronym:ul |
| spelling | engJohn Wiley & Sons, Inc.pt_PTBackground: Cavotricuspid isthmus (CTI) ablation in typical atrial flutter (AFL) restores sinus rhythm in 95% of patients, which may lead to the discontinuation of oral anticoagulation during follow-up. Therefore, we aimed to systematically review the clinical impact of oral anticoagulation in the incidence of thromboembolic events (TE) after typical AFL ablation. Methods: We searched for controlled studies evaluating the impact of anticoagulation in the incidence of TE in patients submitted to AFL ablation in MEDLINE, CENTRAL, PsycINFO database (June/2021). The primary outcome was TE events (ischemic stroke or systemic embolism). A meta-analysis was performed deriving risk ratios (RR) and 95% confidence intervals (CI). Statistical heterogeneity was measured through I2 metric. The confidence in the evidence was appraised with Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. Results: Eight observational studies with 4870 patients were included. TE events were not significantly reduced (RR 1.18, 95% CI 0.59-2.36; n = 4870; GRADE very low). A meta-regression showed that for each 10% increase in the prevalence of previous AF in the studied population, anticoagulation reduced TE risk in 32%. There were no significant differences regarding bleeding events (RR 2.16, 95% CI 0.43-10.97, I2 = 0%; GRADE low), but there was a lower all-cause mortality (RR 0.24, 95% CI 0.17-0.32, GRADE low). Conclusion: The best available evidence lacks robustness and the data did not definitely associate anticoagulation after typical AFL ablation with reduced TE.application/pdfpt_PTAnticoagulation after typical atrial flutter ablation: systematic review and meta‐analysisPersonalFerreira, Afonso NunesDSpacehttp://dspace.org/items/ea30d6c6-61a5-4dc8-a175-d4b3631c168aDSpacehttp://dspace.org/items/ea30d6c6-61a5-4dc8-a175-d4b3631c168aNunes-FerreiraAfonsoCiência IDhttps://www.ciencia-id.pt0419-C014-BA22ORCIDhttp://orcid.org0000-0002-2836-9497PersonalAlves, MarianaDSpacehttp://dspace.org/items/6fd2983b-8b7d-452d-b03b-999007533ee0DSpacehttp://dspace.org/items/6fd2983b-8b7d-452d-b03b-999007533ee0AlvesMarianaCiência IDhttps://www.ciencia-id.pt0718-09A9-D4EAORCIDhttp://orcid.org0000-0002-1369-8423Researcher IDhttps://www.researcherid.comO-3034-2016Scopus Author IDhttps://www.scopus.com56591535500PersonalLima Da Silva, GustavoDSpacehttp://dspace.org/items/19eb513b-6abf-4171-905e-8d8c36a33c6cDSpacehttp://dspace.org/items/19eb513b-6abf-4171-905e-8d8c36a33c6cLima da SilvaGustavoCiência IDhttps://www.ciencia-id.ptFB15-EB01-5F40ORCIDhttp://orcid.org0000-0003-3138-8354PersonalCortez-Dias, NunoDSpacehttp://dspace.org/items/36f4a32d-38e4-4c28-9140-4ba468059a22DSpacehttp://dspace.org/items/36f4a32d-38e4-4c28-9140-4ba468059a22Cortez-DiasNunoCiência IDhttps://www.ciencia-id.ptD612-D3C3-6E1DORCIDhttp://orcid.org0000-0002-9244-4631PersonalDe Sousa, JoãoDSpacehttp://dspace.org/items/ea6febb2-da5d-4296-a20a-3adac1f59117DSpacehttp://dspace.org/items/ea6febb2-da5d-4296-a20a-3adac1f59117de SousaJoãoCiência IDhttps://www.ciencia-id.pt7D1D-FC15-13D6ORCIDhttp://orcid.org0000-0003-2782-8214PersonalPinto, Fausto J.DSpacehttp://dspace.org/items/5f44176f-69f5-482c-83cd-ab94425a6ec3DSpacehttp://dspace.org/items/5f44176f-69f5-482c-83cd-ab94425a6ec3PintoFausto J.Ciência IDhttps://www.ciencia-id.ptC311-AEDD-6DBBORCIDhttp://orcid.org0000-0002-8034-4529Researcher IDhttps://www.researcherid.comG-9363-2015Researcher IDhttps://www.researcherid.comGQA-4584-2022Scopus Author IDhttps://www.scopus.com7102740158PersonalCaldeira, DanielDSpacehttp://dspace.org/items/eba36bb8-5eb3-4ccc-88f8-bd7012d42382DSpacehttp://dspace.org/items/eba36bb8-5eb3-4ccc-88f8-bd7012d42382CaldeiraDanielCiência IDhttps://www.ciencia-id.ptAA19-EC35-8D01ORCIDhttp://orcid.org0000-0002-2520-5673Scopus Author IDhttps://www.scopus.com36623384200HostingInstitutionOrganizationalRepositório Científico de Acesso Aberto da ULisboae-mailmailto:repositorio@reitoria.ulisboa.ptrepositorio@reitoria.ulisboa.ptISSNIsPartOf0147-8389DOIIsPartOf10.1111/pace.143422021-09-17T16:07:23Z20212021-01-01T00:00:00ZHandlehttp://hdl.handle.net/10451/49543http://purl.org/coar/access_right/c_16ecrestricted accessCavotricuspid isthmus ablationOral anticoagulationThromboembolic eventsTypical atrial flutter793664 bytesliteraturehttp://purl.org/coar/resource_type/c_6501journal articlehttp://purl.org/coar/access_right/c_16ecapplication/pdffulltexthttps://repositorio.ulisboa.pt/bitstreams/c95abfa3-365c-43fc-be77-f4619a8a9e74/downloadPacing and Clinical Electrophysiology |
| spellingShingle | Anticoagulation after typical atrial flutter ablation: systematic review and meta‐analysis Anticoagulation after typical atrial flutter ablation: systematic review and meta‐analysis Ferreira, Afonso Nunes Cavotricuspid isthmus ablation Oral anticoagulation Thromboembolic events Typical atrial flutter Ferreira, Afonso Nunes Cavotricuspid isthmus ablation Oral anticoagulation Thromboembolic events Typical atrial flutter |
| status | SINGLETON |
| subject.fl_str_mv | Cavotricuspid isthmus ablation Oral anticoagulation Thromboembolic events Typical atrial flutter |
| title | Anticoagulation after typical atrial flutter ablation: systematic review and meta‐analysis |
| title_full | Anticoagulation after typical atrial flutter ablation: systematic review and meta‐analysis |
| title_fullStr | Anticoagulation after typical atrial flutter ablation: systematic review and meta‐analysis Anticoagulation after typical atrial flutter ablation: systematic review and meta‐analysis |
| title_full_unstemmed | Anticoagulation after typical atrial flutter ablation: systematic review and meta‐analysis Anticoagulation after typical atrial flutter ablation: systematic review and meta‐analysis |
| title_short | Anticoagulation after typical atrial flutter ablation: systematic review and meta‐analysis |
| title_sort | Anticoagulation after typical atrial flutter ablation: systematic review and meta‐analysis |
| topic | Cavotricuspid isthmus ablation Oral anticoagulation Thromboembolic events Typical atrial flutter |
| topic_facet | Cavotricuspid isthmus ablation Oral anticoagulation Thromboembolic events Typical atrial flutter |
| url | http://hdl.handle.net/10451/49543 |
| visible | 1 |