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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
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  • 2023
Published in:
  • Journal of clinical medicine. - 2023, vol. 12, no. 14, p. 4814
Direct-acting oral anticoagulants’ management
Leadless pacing
Anticoagulation 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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Language
  • English
Classification
Medicine
License
CC BY
Open access status
gold
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Persistent URL
https://n2t.net/ark:/12658/srd1332216
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