B-PO01-038 ANTITHROMBOTIC USE AND RISK OF HEMATOMA DURING CARDIAC DEVICE PROCEDURES: INSIGHTS FROM THE WRAP-IT TRIAL

Abstract

Antithrombotic therapy is common among patients undergoing cardiac implantable electronic device (CIED) procedures. Risk of hematoma varies by anticoagulant therapy interruption, use of heparin bridging, and concomitant use of antiplatelet (AP) therapy. To evaluate the relationship between AC and AP use and the risk of hematoma. This multivariable analysis included 6,800 patients from the WRAP-IT trial; 3,832 patients were not on AC, 1,419 had therapy interrupted, and 1,160 had continued therapy. Patients were stratified by type of AC (warfarin vs. direct oral AC [DOAC]), strategy of AC management (uninterrupted, interrupted, bridging) and concomitant use of AP at the time of procedure. The endpoint for physician reported hematoma was postoperative hematoma within 30 days. The overall hematoma rate was 2.22% (0.82% without AC or AP, 2.50% with AC alone, 4.58% with AC and AP; Figure). AP use was associated with almost doubling of risk vs. no AP (HR=1.88, p=0.0005) in the general population. Type of oral AC (OAC) strategy resulted in varying risk of hematoma (p<0.0001); compared to no therapy. Bridging was the highest risk (HR=5.02) while interrupted was the lowest (HR=2.07). Type of OAC strategy did not result in increased cerebrovascular event risk through 3 years follow up. In patients undergoing CIED procedures, AC increases the risk of hematoma especially when combined with AP use. For patients on therapy, interrupted OAC strategy was associated with the lowest rate of hematomas without an increased cerebrovascular event risk in this large cohort. The findings could help guide AC management to mitigate the risk of hematoma.