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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 LakkireddyEmail author
Article
  • 81 Downloads

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.

Keywords

Direct anticoagulation agents Cardiac devices Warfarin 

Abbreviations

DOAC

Direct oral anticoagulation

AF

Atrial fibrillation

CIED

Cardiac implantable electronic device

INR

International normalized ratio

Notes

Contributions

Jayasree Pillarisetti—idea, concept, design, data analysis, manuscript preparation

Ryan Maybrook—idea, assisted in manuscript preparation

Valay Parikh—data analysis

Nivedita Adabala—data collection, manuscript review

Mehdi Khalafi—data collection, manuscript review

Sandeep Reddy—data collection, manuscript review

Sudharani Bommana MPhil—database support

Prajwala Lakkireddy—database support

Rakesh Gopinnathanair MD—manuscript review

Sanghamitra Mohanty—manuscript review

Luigi Di Biase—manuscript review

Madhu Yeruva Reddy—manuscript review

Andrea Natale—manuscript review

Sanjeev Saksena—manuscript review

Dhanunjaya Lakkireddy—critical revision of manuscript

Compliance with ethical standards

Conflict of interest

Dr. Lakkireddy is a speaker for Janssen, Boehringer Ingelheim, and Pfizer/Bristol-Myers Squibb. Dr. Luigi Di Biase is a consultant to Pfizer/Bristol-Myers Squibb. Dr. Madhu Reddy is a speaker for Pfizer/Bristol-Myers Squibb. Dr. Gopinathannair is a speaker for Pfizer/Bristol-Myers Squibb. Dr. Saksena held a research grant from Daiichi Sankyo. All other authors have no relevant conflict of interest to disclose.

The work is original and is not published elsewhere.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Jayasree Pillarisetti
    • 1
  • Ryan Maybrook
    • 2
  • Valay Parikh
    • 2
  • Nivedita Adabala
    • 2
  • Mehdi Khalafi
    • 2
  • Sandeep Reddy
    • 2
  • Sudharani Bommana
    • 2
  • Prajwala Lakkireddy
    • 2
  • Madhu Yeruva Reddy
    • 2
  • Carola Gianni
    • 3
  • Rakesh Gopinathannair
    • 4
  • Sanghamitra Mohanty
    • 3
  • Luigi Di Biase
    • 3
  • Andrea Natale
    • 3
  • Sanjeev Saksena
    • 5
  • Dhanunjaya Lakkireddy
    • 4
    Email author
  1. 1.UT Health San AntonioSan AntonioUSA
  2. 2.University of KansasKansas CityUSA
  3. 3.Texas Cardiac ArrhythmiaAustinUSA
  4. 4.Division of Cardiovascular DiseasesKansas City Heart Rhythm InstituteOverland ParkUSA
  5. 5.UMDNJ-Robert Wood Johnson School of MedicineNew BrunswickUSA

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