Peri-procedural use of direct anticoagulation agents during cardiac device implantation: vitamin K antagonists vs direct oral anticoagulants
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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.
We wanted to compare three DOAC agents with warfarin during cardiac device implantation.
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.
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.
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.
KeywordsDirect anticoagulation agents Cardiac devices Warfarin
Direct oral anticoagulation
Cardiac implantable electronic device
International normalized ratio
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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