Preprint Article Version 1 Preserved in Portico This version is not peer-reviewed

Peri-Procedural Management of Direct-Acting Oral Anticoagulants (DOACs) in Transcatheter Miniaturized Leadless Pacemaker Implantation

François Diederik Regoli
* ,
Ardan M. Saguner
ORCID logo ,
Angelo Auricchio
,
Andrea Demarchi
,
Elena Pasotti
* ,
Giulio Conte
,
Maria Luce Caputo
* ORCID logo ,
Tardu Özkartal
ORCID logo ,
Alexander Breitenstein
Version 1 : Received: 30 June 2023 / Approved: 30 June 2023 / Online: 30 June 2023 (14:43:33 CEST)

A peer-reviewed article of this Preprint also exists.

Regoli, F.D.; Saguner, A.M.; Auricchio, A.; Demarchi, A.; Pasotti, E.; Conte, G.; Caputo, M.L.; Özkartal, T.; Breitenstein, A. Peri-Procedural Management of Direct-Acting Oral Anticoagulants (DOACs) in Transcatheter Miniaturized Leadless Pacemaker Implantation. J. Clin. Med. 2023, 12, 4814. Regoli, F.D.; Saguner, A.M.; Auricchio, A.; Demarchi, A.; Pasotti, E.; Conte, G.; Caputo, M.L.; Özkartal, T.; Breitenstein, A. Peri-Procedural Management of Direct-Acting Oral Anticoagulants (DOACs) in Transcatheter Miniaturized Leadless Pacemaker Implantation. J. Clin. Med. 2023, 12, 4814.

Abstract

Introduction: Data on peri-operative management of direct-acting oral anticoagulants (DOACs) during transcatheter pacing leadless system (TPS) implantation remain limited. This study aimed to evaluate a standardized DOAC management regime consisting in interruption of a single dose prior to implantation and reinitiation within 6-24 hours; also, patient clinical characteristics associated with this approach were identified. Method Consecutive patients undergoing standard TPS implantation procedure from two Swiss tertiary centers were included. DOAC peri-operative management included the standardized approach (Group 1A) or other different approaches (Group 1B). Results Three hundred and ninety two pts (mean age 81.4±7.3 years, 66.3% male, left ventricular ejection fraction 55.5±9.6%) underwent TPS implantation. Two hundred and eighty two pts (71.9%) were under anticoagulation therapy: 192 pts were treated with DOAC; 90 pts were under vitamin-K antagonist. Patients treated with DOAC less often had structural heart disease, diabetes mellitus, and advanced renal failure. The rate of major peri-procedural complications did not differ between Groups 1A (n=115) and 1B (n=77) (2.6% and 3.8%, p=0.685). Compared to 1B, 1A patients were implanted with TPS for slow ventricular rate atrial fibrillation (AF)(p=0.002), were in better overall clinical status, and were implanted electively (<0.001). Conclusions Standardized peri-procedural DOAC management was more often implemented for elective TPS procedure and did not seem to increase bleeding or thromboembolic adverse events.

Keywords

leadless pacing; anticoagulation management during pacing

Subject

Medicine and Pharmacology, Cardiac and Cardiovascular Systems

Copyright: This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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