Perioperative management of antithrombotic treatment during implantation or revision of cardiac implantable electronic devices: the European Snapshot Survey on Procedural Routines for Electronic Device Implantation (ESS-PREDI).
The European Snapshot Survey on Procedural Routines for Electronic Device Implantation (ESS-PREDI) was a prospective European survey of consecutive adults who had undergone implantation/surgical revision of a cardiac implantable electronic device (CIED) on chronic antithrombotic therapy (enrolment March-June 2015). The aim of the survey was to investigate perioperative treatment with oral anticoagulants and antiplatelets in CIED implantation or surgical revision and to determine the incidence of complications, including clinically significant pocket haematomas. Information on antithrombotic therapy before and after surgery and bleeding and thromboembolic complications occurring after the intervention was collected at first follow-up. The study population comprised 723 patients (66.7% men, 76.9% aged ≥66 years). Antithrombotic treatment was continued during surgery in 489 (67.6%) patients; 6 (0.8%) had their treatment definitively stopped; 46 (6.4%) were switched to another antithrombotic therapy. Heparin bridging was used in 55 out of 154 (35.8%) patients when interrupting vitamin K antagonist (VKA) treatment. Non-vitamin K oral anticoagulant (NOAC) treatment was interrupted in 88.7% of patients, with heparin bridging in 25.6%, but accounted for only 25.3% of the oral anticoagulants used. A total of 108 complications were observed in 98 patients. No intracranial haemorrhage or embolic events were observed. Chronic NOAC treatment before surgery was associated with lower rates of minor pocket haematoma (1.4%; P= 0.042) vs. dual antiplatelet therapy (13.0%), VKA (11.4%), VKA + antiplatelet (9.2%), or NOAC + antiplatelet (7.7%). Similar results were observed for bleeding complications (P= 0.028). Perioperative management of patients undergoing CIED implantation/surgical revision while on chronic antithrombotic therapy varies, with evidence of a disparity between guideline recommendations and practice patterns in Europe. Haemorrhagic complications were significantly less frequent in patients treated with NOACs. Despite this, the incidence of severe pocket haematomas was low.
['Deharo|Jean-Claude|JC|', 'Sciaraffia|Elena|E|', 'Leclercq|Christophe|C|', 'Amara|Walid|W|', 'Doering|Michael|M|', 'Bongiorni|Maria G|MG|', 'Chen|Jian|J|', 'Dagres|Nicolaus|N|', 'Estner|Heidi|H|', 'Larsen|Torben B|TB|', 'Johansen|Jens B|JB|', 'Potpara|Tatjana S|TS|', 'Proclemer|Alessandro|A|', 'Pison|Laurent|L|', 'Brunet|Caroline|C|', 'Blomström-Lundqvist|Carina|C|', '|||']
D000293:Adolescent D000328:Adult D000368:Aged D000369:Aged, 80 and over D000925:Anticoagulants D017147:Defibrillators, Implantable D005060:Europe D005260:Female D006406:Hematoma D006470:Hemorrhage D006801:Humans D008297:Male D008875:Middle Aged D010138:Pacemaker, Artificial D059035:Perioperative Period D011183:Postoperative Complications D011446:Prospective Studies D012086:Reoperation D011795:Surveys and Questionnaires D055815:Young Adult
Cardiac implantable electronic device Antithrombotic therapy Antiplatelet Pocket haematoma Bleeding Non-vitamin K oral anticoagulants EHRA survey Warfarin