Oral anticoagulation management in patients with atrial fibrillation undergoing cardiac implantable electronic device implantation

Background Oral anticoagulation (OAC) therapy is associated with increased periprocedural risks after cardiac implantable electronic device (CIED) implantation. Patterns of anticoagulation management involving non–vitamin K antagonist oral anticoagulants (NOACs) have not been characterized. Hypothes...

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Bibliographic Details
Published in:Clinical cardiology (Mahwah, N.J.) N.J.), 2017-09, Vol.40 (9), p.746-751
Main Authors: Black‐Maier, Eric, Kim, Sunghee, Steinberg, Benjamin A., Fonarow, Gregg C., Freeman, James V., Kowey, Peter R., Ansell, Jack, Gersh, Bernard J., Mahaffey, Kenneth W., Naccarelli, Gerald, Hylek, Elaine M., Go, Alan S., Peterson, Eric D., Piccini, Jonathan P.
Format: Article
Language:English
Subjects:
Administration, Oral
Aged
Aged, 80 and over
Anticoagulants
Anticoagulants - administration & dosage
Anticoagulants - adverse effects
Anticoagulation
Atrial Fibrillation
Atrial Fibrillation - complications
Atrial Fibrillation - diagnosis
Atrial Fibrillation - physiopathology
Atrial Fibrillation - therapy
Cardiac arrhythmia
Cardiac Implantable Electronic Device
Cardiac Pacing, Artificial - adverse effects
Cardiac Resynchronization Therapy
Cardiac Resynchronization Therapy Devices
Clinical Investigations
Coagulation
Defibrillators, Implantable
Drug Administration Schedule
Drug Substitution
Electric Countershock - adverse effects
Electric Countershock - instrumentation
Female
Hemorrhage - chemically induced
Humans
Male
Middle Aged
Pacemaker, Artificial
Registries
Risk Factors
Stroke - etiology
Stroke - prevention & control
Time Factors
Treatment Outcome
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Summary:Background Oral anticoagulation (OAC) therapy is associated with increased periprocedural risks after cardiac implantable electronic device (CIED) implantation. Patterns of anticoagulation management involving non–vitamin K antagonist oral anticoagulants (NOACs) have not been characterized. Hypothesis Anticoagulation strategies and outcomes differ by anticoagulant type in patients undergoing CIED implantation. Methods Using the nationwide Outcomes Registry for Better Informed Treatment of Atrial Fibrillation, we assessed how atrial fibrillation (AF) patients undergoing CIED implantation were cared for and their subsequent outcomes. Outcomes were compared by oral anticoagulant therapy (none, warfarin, or NOAC) as well as by anticoagulation interruption status. Results Among 9129 AF patients, 416 (5%) underwent CIED implantation during a median follow‐up of 30 months (interquartile range, 24–36). Of these, 60 (14%) had implantation on a NOAC. Relative to warfarin therapy, those on a NOAC were younger (70.5 years [range, 65–77.5 years] vs 77 years [range, 70–82 years]), had less valvular heart disease (15.0% vs 31.3%), higher creatinine clearance (67.3 [range, 59.7–99.0] vs 65.8 [range, 50.0–91.6]), were more likely to have persistent AF (26.7% vs 22.9%), and use concomitant aspirin (51.7% vs 35.2%). OAC therapy was commonly interrupted for CIED in 64% (n = 183 of 284) of warfarin patients and 65% (n = 39 of 60) of NOAC patients. Many interrupted patients received intravenous bridging anticoagulation: 33/183 (18%) interrupted warfarin and 4/39 (10%) interrupted NOAC patients. Thirty‐day periprocedure bleeding and stroke adverse events were infrequent. Conclusions Management of anticoagulation among AF patients undergoing CIED implantation is highly variable, with OAC being interrupted in more than half of both warfarin‐ and NOAC‐treated patients. Bleeding and stroke events were infrequent in both warfarin and NOAC‐treated patients.
ISSN:0160-9289
1932-8737
DOI:10.1002/clc.22726