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OUTCOMES OF PERIPROCEDURAL ANTICOAGULATION THERAPY WITH WARFARIN VERSUS NEW ORAL ANTICOAGULANTS IN PATIENTS UNDERGOING CARDIAC IMPLANTABLE ELECTRONIC DEVICE PLACEMENT
826 JACC April 5, 2016 Volume 67, Issue 13
Arrhythmias and Clinical EP OUTCOMES OF PERIPROCEDURAL ANTICOAGULATION THERAPY WITH WARFARIN VERSUS NEW ORAL ANTICOAGULANTS IN PATIENTS UNDERGOING CARDIAC IMPLANTABLE ELECTRONIC DEVICE PLACEMENT Poster Contributions Poster Area, South Hall A1 Sunday, April 03, 2016, 3:45 p.m.-4:30 p.m. Session Title: Insights Into New Therapies in Electrophysiology and Devices Abstract Category: 18. Arrhythmias and Clinical EP: Devices Presentation Number: 1233-334 Authors: Lena Trager, Cesar Martinez, Ross Garberich, Tamara Langeberg, Jay Sengupta, Leah Kupiers, JoEllyn Abraham, Raed Abdelhadi, Minneapolis Heart Institute, Minneapolis, MN, USA
Background: With increasing utilization of new oral anticoagulants (NOACs), data are needed to guide therapy in patients anticipating procedures such as Cardiac Implantable Electronic Device (CIED) placement. There are limited data comparing outcomes with warfarin and NOACs apixaban, dabigatran, and rivaroxaban in this patient population. The objective of this study was to assess current periprocedural anticoagulation in patients undergoing CIED placement and compare 30-day outcomes in patients on NOACs versus warfarin.
Methods: This was a single center retrospective study. We identified adults who underwent CIED placement from 1/01/2011 to 8/10/2014 at a large tertiary center based on their diagnosis codes and cross-referenced this data with patients with prescriptions for warfarin, apixaban, dabigatran, or rivaroxaban. We extracted relevant clinical data from the electronic medical records including procedure type, anticoagulant timeframe, bleeding and thromboembolic events, and mortality within 30 days of the procedure. Propensity matching was used to compare patients on warfarin versus NOACs at the time of their procedure. Results: Of 1,834 patients undergoing CIED placement, 43 patients were on NOACs. In our database of 883 patients on warfarin, we matched a comparison group of 48 patients with similar baseline demographics. During a follow-up of 30 days, there were 5 (12%) bleeding events in the NOAC group. All events were hematomas with 2 requiring surgical intervention. There were 4 (8%) hematomas in the warfarin group; none required surgical intervention. Furthermore, in the NOAC group there was one thromboembolic event (occluded popliteal artery), compared to none in the warfarin group. There were no patient deaths in either group.
Conclusions: Periprocedural NOAC management is poorly defined. There is significant variability in the number of held doses of NOACs at the time of CIED placement. Numerically, there were more bleeding events in patients on NOACs compared to warfarin, and there was a thromboembolic event in the NOAC group. Concomitant anti-platelet agents and NOAC doses held post-procedure may impact event rates.
Arrhythmias and Clinical EP OUTCOMES OF PERIPROCEDURAL ANTICOAGULATION THERAPY WITH WARFARIN VERSUS NEW ORAL ANTICOAGULANTS IN PATIENTS UNDERGOING CARDIAC IMPLANTABLE ELECTRONIC DEVICE PLACEMENT Poster Contributions Poster Area, South Hall A1 Sunday, April 03, 2016, 3:45 p.m.-4:30 p.m. Session Title: Insights Into New Therapies in Electrophysiology and Devices Abstract Category: 18. Arrhythmias and Clinical EP: Devices Presentation Number: 1233-334 Authors: Lena Trager, Cesar Martinez, Ross Garberich, Tamara Langeberg, Jay Sengupta, Leah Kupiers, JoEllyn Abraham, Raed Abdelhadi, Minneapolis Heart Institute, Minneapolis, MN, USA
Background: With increasing utilization of new oral anticoagulants (NOACs), data are needed to guide therapy in patients anticipating procedures such as Cardiac Implantable Electronic Device (CIED) placement. There are limited data comparing outcomes with warfarin and NOACs apixaban, dabigatran, and rivaroxaban in this patient population. The objective of this study was to assess current periprocedural anticoagulation in patients undergoing CIED placement and compare 30-day outcomes in patients on NOACs versus warfarin.
Methods: This was a single center retrospective study. We identified adults who underwent CIED placement from 1/01/2011 to 8/10/2014 at a large tertiary center based on their diagnosis codes and cross-referenced this data with patients with prescriptions for warfarin, apixaban, dabigatran, or rivaroxaban. We extracted relevant clinical data from the electronic medical records including procedure type, anticoagulant timeframe, bleeding and thromboembolic events, and mortality within 30 days of the procedure. Propensity matching was used to compare patients on warfarin versus NOACs at the time of their procedure. Results: Of 1,834 patients undergoing CIED placement, 43 patients were on NOACs. In our database of 883 patients on warfarin, we matched a comparison group of 48 patients with similar baseline demographics. During a follow-up of 30 days, there were 5 (12%) bleeding events in the NOAC group. All events were hematomas with 2 requiring surgical intervention. There were 4 (8%) hematomas in the warfarin group; none required surgical intervention. Furthermore, in the NOAC group there was one thromboembolic event (occluded popliteal artery), compared to none in the warfarin group. There were no patient deaths in either group.
Conclusions: Periprocedural NOAC management is poorly defined. There is significant variability in the number of held doses of NOACs at the time of CIED placement. Numerically, there were more bleeding events in patients on NOACs compared to warfarin, and there was a thromboembolic event in the NOAC group. Concomitant anti-platelet agents and NOAC doses held post-procedure may impact event rates.