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Background: Periprocedural bleeding risk among patients on direct oral anticoagulants (DOAC) undergoing cardiac implantable electronic device (CIED) implantation is high. Local tranexamic acid (TXA) has been proposed as an effective method in reducing of bleeding complications during various surgical operations including CIED. The purpose was to evaluate major bleeding complications in patients undergoing CIED implantation while on different chronic DOAC treatments.
Methods: A retrospective analysis of consecutive patients undergoing CIED implantation while on DOACs was provided. Major bleeding (MB) was defined as any bleeding leading to transfusion, surgical intervention for pocket evacuation or revision, pericardial effusion, hemothorax, or life-threatening bleed. Pocket hematoma (PH) was defined as swelling and a painful mass with ecchymosis formation extending the margin of generators. DOACs were classified into two as Factor IIa and Factor Xa inhibitors. All patients were administered 1500 mg of TXA locally during implantation procedure according to predefined strict hospital protocol.
Results: A total of 51 consecutive patients were identified and included in this analysis. Twenty five patients were on chronic Factor IIa inhibitor and 26 patients were on chronic factor Xa inhibitors. DOAC was perioperatively uninterrupted in one third of patients in both groups. Two groups were similar to each other at baseline including age (61.9+/-9 vs 57+/-9 years, p=0.205), gender distribution (14vs.19 males, p=0.326) dual antiplatelets (24% vs. 19.2%, p=0.941), with the most frequently implanted device as ICD in both groups (84% vs 80%, p=1.0). Pocket hematoma was more frequent with Factor Xa inhibitors than Factor IIa inhibitors (30.8% vs. 4%, p=0.024), and, major bleeding was noted in 3 patients on Factor Xa inhibitors whereas no patient on Factor IIa inhibitor.
Conclusions: Local TXA has recently been reported to prevent bleeding complications in high risk patients undergoing CIED implantation. However, when it comes to DOACs, there seems a different performance of local TXA with better performance while the patient was on chronic Factor IIa inhibitor versus Factor Xa inhibitors.
Poster Hall, Hall C
Saturday, March 18, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Arrhythmias and Clinical EP: Anticoagulation Issues
Abstract Category: 6. Arrhythmias and Clinical EP: Other
Presentation Number: 1189-088
- 2017 American College of Cardiology Foundation