Peri-procedural use of direct anticoagulation agents during cardiac device implantation: vitamin K antagonists vs direct oral anticoagulants

Jayasree Pillarisetti, Ryan Maybrook, Valay Parikh, Nivedita Adabala, Mehdi Khalafi, Sandeep Reddy, Sudharani Bommana, Prajwala Lakkireddy, Madhu Yeruva Reddy, Carola Gianni, Rakesh Gopinathannair, Sanghamitra Mohanty, Luigi Di Biase, Andrea Natale, Sanjeev Saksena, Dhanunjaya Lakkireddy

Research output: Contribution to journalArticle

Abstract

Background: Warfarin is deemed safe compared to bridging with heparin in the peri-procedure setting while implanting cardiac devices. The timing of discontinuation and re-initiation of direct anticoagulant agents (DOACs) such as dabigatran, apixaban, and rivaroxaban in the peri-procedural setting in comparison to warfarin is not well studied. Objective: We wanted to compare three DOAC agents with warfarin during cardiac device implantation. Methods: Consecutive patients on treatment with dabigatran, rivaroxaban, or apixaban (group A) undergoing a cardiac device generator change, upgrade, or new implantation procedure were compared to those on warfarin (group B). Incidence of hematoma, infection, effusion, stroke, and other complications were noted at 1 day, 1 week, and 3 months. Results: A total of 311 patients in group A underwent the above procedures with 73 patients on dabigatran, 153 on rivaroxaban, and 85 on apixaban. There were 467 patients on warfarin in group B. Mean age of the total population was 68 ± 12 years with 67% males and > 80% Caucasians. The last dose of the DOAC was the night prior to the procedure and resumed the night of the procedure (single dose interruption for apixaban and dabigatran and no un-interruption for rivaroxaban). There was no difference noted in the incidence of minor or major hematoma (9% vs 8.5%, p = 0.7). No stroke occurred in either group. Conclusion: Use of DOAC agents with transient interruption of one dose is as safe as warfarin in the peri-procedural setting during implantation of cardiac devices.

Original languageEnglish (US)
JournalJournal of Interventional Cardiac Electrophysiology
DOIs
StateAccepted/In press - Jan 1 2019
Externally publishedYes

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Keywords

  • Cardiac devices
  • Direct anticoagulation agents
  • Warfarin

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Pillarisetti, J., Maybrook, R., Parikh, V., Adabala, N., Khalafi, M., Reddy, S., Bommana, S., Lakkireddy, P., Reddy, M. Y., Gianni, C., Gopinathannair, R., Mohanty, S., Di Biase, L., Natale, A., Saksena, S., & Lakkireddy, D. (Accepted/In press). Peri-procedural use of direct anticoagulation agents during cardiac device implantation: vitamin K antagonists vs direct oral anticoagulants. Journal of Interventional Cardiac Electrophysiology. https://doi.org/10.1007/s10840-019-00646-4