Risk factors associated with bleeding after multi antithrombotic therapy during implantation of cardiac implantable...

Area of Science:

• Cardiology
• Medical Devices
• Thrombosis Management

Background:

• Previous studies indicate safety of single antithrombotic therapies during CIED implantations.
• The safety profile of continuous multi-antithrombotic therapy (AT) in CIED interventions remains unclear.

Purpose of the Study:

• To evaluate the safety of continuous multi-antithrombotic therapy (AT) during cardiac implantable electronic device (CIED) implantations.
• To assess the incidence of perioperative complications, specifically clinically significant pocket hematomas (PH) and thromboembolism.

Main Methods:

• A prospective study involving 300 patients undergoing CIED implantations.
• Patients were categorized into six groups based on antithrombotic therapy: No-AT, oral anticoagulant therapy (OAT), single antiplatelet therapy (SAPT), OAT + SAPT, dual antiplatelet therapy (DAPT), and triple AT (TAT).
• Clinically significant PH was defined as requiring surgical intervention, prolonged hospitalization, AT interruption, or blood transfusion.

Main Results:

• No significant difference in the occurrence of clinically significant PH or thromboembolism was observed among the six AT groups (p=0.145 and p=0.795, respectively).
• High HAS-BLED score (p=0.014) and valvular heart disease (VHD) (p=0.015) were significantly associated with an increased risk of clinically significant PH.
• Continuous multi-AT regimens were generally tolerated during CIED procedures.

Conclusions:

• Continuous multi-antithrombotic therapy (AT) appears to be a safe option for patients undergoing cardiac implantable electronic device (CIED) procedures.
• Careful attention and risk stratification are necessary for patients with a high HAS-BLED score or valvular heart disease undergoing CIED implantations due to increased risk of pocket hematomas.