Evaluation Of Two Thromboembolism (TE) Risk Methods And Oral Anticoagulation Use Among Cardiac Device Patients With...

In the implantable cardiac device (CD) population, not only can clinically silent atrial tachyarrythmias (AT) be detected, but an associated AT burden can be documented. There are two methods of determining stroke risk: CHADS₂ and CHA₂DS₂-VASc. Recommendations for initiating anticoagulation based on stroke risk profiles and/or AT burden remain unclear for device-detected AT.

Aims of this study were to reveal the AT burden among CD patients, determine CHADS₂ and CHA₂DS₂-VASc scores among patients with an AT burden, and evaluate current practices for anticoagulation.

Records were reviewed from patients undergoing a new CD implant within the last three years from two device clinics. Continuous variables were expressed as mean with standard deviation (SD) and categorical variables were stated as numbers and percentages. The categorical variables were compared using the Chi2 Square test and the continuous variables were compared using the independent 2-sided t-test.

There were 275 CD patients enrolled. Eighty-seven had an AT burden and 188 patients did not have an AT burden. CD patients with AT burden were older than those without AT burden [69 (11), p=0.007]. Patients with AT burden had more hypertension and previous history of stroke (p=0.038, p=0.005) compared to those without AT burden. Both the CHADS₂ and CHA₂DS₂-VASc mean scores were higher in patients with an AT burden (p=0.018 and p=0.041). Thirty patients with a previous history of AT were on anticoagulation (p=<0.001) prior to implant. Forty-eight patients had a new diagnosis of AT (NDAT) and 46% (n=22) were started on anticoagulation.

An AT burden was detected in 32% of patients with at least 75% falling within a high-risk category using both scores. However, less than half of NDAT patients were started on anticoagulation. The use of oral anticoagulation in practice remains inconsistent and further randomized trials are recommended.