Abstract 15797: Peri-procedural Use of Novel Anticoagulation Agents During Cardiac Device Implantation

Abstract

Introduction: The timing of discontinuation and re-initiation of novel anticoagulant agents (NOACs) such as dabigatran, apixaban and rivaroxaban in the peri-procedural setting is important to minimize the risk of stroke and procedure-related bleeding. Methods: Consecutive patients who were on treatment with either dabigatran, rivaroxaban or apixaban and underwent a cardiac device generator change, upgrade or new implantation procedure at two high volume centers were noted (Group A). Age and gender matched patients on warfarin who underwent similar procedures were collected for controls (Group B). Patients were followed for three months for hematoma and other complications. Results: A total of 185 patients in group A underwent above procedures with new device implant in 50%, device upgrade in 23% and generator change in 25% of patients. There were 61 patients on dabigatran, 90 on rivaroxaban, 34 on apixaban in group A and 185 patients on coumadin in group B. Mean age of the total population was 68±12 years with 71% males and 84% Whites with no differences between groups. There were more patients on dual antiplatelet therapy in group A (10%) compared to group B (1%). Mean INR in Group B was 2.1 pre and post procedure. In 3 patients, NOACs were held for 24 to 48 hours prior to the procedure, while they were continued un-interrupted in the rest of the patients. NOACs were resumed after the procedure within 24 hours in all patients except in one patient. There was no difference noted in the incidence of minor or major hematoma in each of these groups (see table). None of the patients in Group A required evacuation. Two patients in Group B developed infection of the hematoma that prompted extraction of the device. No stroke or bleeding related complications were noted in both groups Conclusion: Uninterrupted use of the NOACs is safe in the peri-procedural setting during implantation of cardiac devices. Our study is the first to compare the three NOACs with warfarin.