TY - JOUR
T1 - Peri-procedural use of direct anticoagulation agents during cardiac device implantation
T2 - vitamin K antagonists vs direct oral anticoagulants
AU - Pillarisetti, Jayasree
AU - Maybrook, Ryan
AU - Parikh, Valay
AU - Adabala, Nivedita
AU - Khalafi, Mehdi
AU - Reddy, Sandeep
AU - Bommana, Sudharani
AU - Lakkireddy, Prajwala
AU - Reddy, Madhu Yeruva
AU - Gianni, Carola
AU - Gopinathannair, Rakesh
AU - Mohanty, Sanghamitra
AU - Di Biase, Luigi
AU - Natale, Andrea
AU - Saksena, Sanjeev
AU - Lakkireddy, Dhanunjaya
N1 - Publisher Copyright:
© 2019, Springer Science+Business Media, LLC, part of Springer Nature.
PY - 2020/8/1
Y1 - 2020/8/1
N2 - 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.
AB - 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.
KW - Cardiac devices
KW - Direct anticoagulation agents
KW - Warfarin
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U2 - 10.1007/s10840-019-00646-4
DO - 10.1007/s10840-019-00646-4
M3 - Article
C2 - 31732839
AN - SCOPUS:85075168534
SN - 1383-875X
VL - 58
SP - 141
EP - 146
JO - Journal of Interventional Cardiac Electrophysiology
JF - Journal of Interventional Cardiac Electrophysiology
IS - 2
ER -