Peri-procedural management of direct-acting oral anticoagulants (DOACs) in transcatheter miniaturized leadless pacemaker implantation

Regoli, François Diederik; Saguner, Ardan  M.; Auricchio, Angelo; Demarchi, Andrea; Pasotti, Elena; Conte, Giulio; Caputo, Maria Luce; Özkartal, Tardu; Breitenstein, Alexander

doi:10.3390/jcm12144814

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Regoli_2023_MDPI_Jcm_Peri-Procedural Management

Journal article

Peri-procedural management of direct-acting oral anticoagulants (DOACs) in transcatheter miniaturized leadless pacemaker implantation

Regoli, François Diederik Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland – Service of Cardiology, Hospital of San Giovanni, Cardiocentro Ticino Institute, Bellinzona, Switzerland – Cardiology Department, Cardiocentro Ticino Institute, Lugano, Switzerland
Saguner, Ardan M. University Heart Center Zurich, University Hospital Zurich, Switzerland
Auricchio, Angelo Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland – Cardiology Department, Cardiocentro Ticino Institute, Lugano, Switzerland
Demarchi, Andrea Cardiology Department, Cardiocentro Ticino Institute, Lugano, Switzerland
Pasotti, Elena Cardiology Department, Cardiocentro Ticino Institute, Lugano, Switzerland
Conte, Giulio ORCID Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland – Cardiology Department, Cardiocentro Ticino Institute, Lugano, Switzerland
Caputo, Maria Luce ORCID Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland – Cardiology Department, Cardiocentro Ticino Institute, Lugano, Switzerland
Özkartal, Tardu ORCID Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland – Cardiology Department, Cardiocentro Ticino Institute, Lugano, Switzerland
Breitenstein, Alexander University Heart Center Zurich, University Hospital Zurich, Switzerland

2023

Published in:

Journal of clinical medicine. - 2023, vol. 12, no. 14, p. 4814

Direct-acting oral anticoagulants’ management

Leadless pacemaker implantation

Bleeding complications in leadless pacemaker

English Introduction: Data on peri-operative management of direct-acting oral anticoagulants (DOACs) during transcatheter pacing leadless system (TPS) implantations remain limited. This study aimed to evaluate a standardized DOAC management regime consisting of interruption of a single dose prior to implantation and reinitiation within 6–24 h; also, patient clinical characteristics associated with this approach were identified. Method: Consecutive patients undergoing standard TPS implantation procedures from two Swiss tertiary centers were included. DOAC peri-operative management included the standardized approach (Group 1A) or other approaches (Group 1B). Results: Three hundred and ninety-two pts (mean age 81.4 ± 7.3 years, 66.3% male, left ventricular ejection fraction 55.5 ± 9.6%) underwent TPS implantation. Two hundred and eighty-two pts (71.9%) were under anticoagulation therapy; 192 pts were treated with DOAC; 90 pts were under vitamin-K antagonist. Patients treated with DOAC less often had structural heart disease, diabetes mellitus, and advanced renal failure. The rate of major peri-procedural complications did not differ between groups 1A (n = 115) and 1B (n = 77) (2.6% and 3.8%, p = 0.685). Compared to 1B, 1A patients were implanted with TPS for slow ventricular rate atrial fibrillation (AF) (p = 0.002), in a better overall clinical status, and implanted electively (<0.001). Conclusions: Standardized peri-procedural DOAC management was more often implemented for elective TPS procedures and did not seem to increase bleeding or thromboembolic adverse events.

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