The safety and efficacy of
rivaroxaban in the periprocedural anticoagulation for patients undergoing
catheter ablation of
atrial fibrillation is not well established. We sought to systematically review this evidence using data from multiple studies. A thorough literature search was conducted in MEDLINE, EMABSE, Web of knowledge, clinicaltrials.gov, and the Cochrane library up to November 2014. Studies of at least 100 patients in
rivaroxaban and
warfarin groups were included. Nine observational studies were identified enrolling a total of 4,334 patients (1,210 treated with
rivaroxaban and 3,124 with
warfarin). The primary outcomes were thromboembolic events and major
bleeding. The fixed-effects model meta-analysis was performed and risk ratios (RRs) were calculated. No significant differences were found between patients treated with
rivaroxaban and
warfarin with regard to thromboembolic events (0.25%
rivaroxaban vs. 0.29%
warfarin; RR: 0.61; 95%CI: 0.21-1.76; P=0.36) and major
bleeding (1.03%
rivaroxaban vs. 1.83%
warfarin; RR: 0.51; 95%CI: 0.26-1.00; P=0.05). This meta-analysis suggests that patients treated with
rivaroxaban have a similar incidence of thromboembolic events and major
bleeding compared to
warfarin. Signals were seen favoring
rivaroxaban; however, considering low events rates, more high-quality studies are necessary to thoroughly compare the two strategies.