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The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
Short-term dabigatran interruption before cardiac rhythm device implantation: multi-centre experience from the RE-LY
Vidal Essebag1,2, Riccardo Proietti3,4, David H Birnie5
1McGill University Health Center, 1650 Cedar Ave, Room E5-200, Montreal, QC, Canada H3G 1A4.
Insights
For patients undergoing cardiac device surgery, dabigatran interruption showed similar or lower pocket hematoma rates compared to warfarin. Further research is needed to assess uninterrupted dabigatran's impact on bleeding and stroke.
Area of Science:
- Cardiology
- Pharmacology
- Medical Devices
Background:
- Atrial fibrillation (AF) patients frequently require cardiac implantable electronic device (CIED) surgery.
- Peri-operative anticoagulation management is critical for preventing bleeding and thrombotic events in these patients.
- Comparing direct oral anticoagulants (DOACs) like dabigatran with warfarin is essential for optimizing patient care.
Purpose of the Study:
- To compare peri-operative anticoagulation management strategies.
- To evaluate bleeding and thrombotic event rates in AF patients undergoing CIED surgery.
- To assess outcomes for patients treated with dabigatran versus warfarin.
Main Methods:
- Analysis of 611 AF patients undergoing CIED surgery during the RE-LY trial.
- Comparison of dabigatran (110mg or 150mg twice daily) versus warfarin anticoagulation.
- Evaluation of interruption durations, heparin bridging, pocket hematomas, and ischemic stroke incidence.
Main Results:
- Dabigatran interruption (median 96h) was shorter than warfarin interruption (median 144h).
- Pocket hematomas occurred in 2.20% on dabigatran vs. 3.98% on warfarin (P=0.218).
- Lower hematoma rates were observed with dabigatran compared to warfarin with heparin bridging (P=0.034).
Conclusions:
- Dabigatran interruption in CIED surgery is associated with similar or lower pocket hematoma incidence compared to warfarin.
- Heparin bridging with warfarin did not significantly alter hematoma rates compared to dabigatran.
- Further investigation is required to determine if uninterrupted dabigatran can further reduce pocket hematoma or ischemic stroke.
Aims:
Cardiac implantable electronic device (CIED) surgery is commonly performed in patients with atrial fibrillation (AF). The current analysis was undertaken to compare peri-operative anticoagulation management, bleeding, and thrombotic events in AF patients treated with dabigatran vs. warfarin.
Methods And Results:
This study included 611 patients treated with dabigatran vs. warfarin who underwent CIED surgery during the RE-LY trial. Among 201 warfarin-treated patients, warfarin was interrupted a median of 144 (inter-quartile range, IQR: 120-216) h, and 37 (18.4%) patients underwent heparin bridging. In dabigatran-treated patients (216 on 110 mg bid and 194 on 150 mg bid), the duration of dabigatran interruption was a median of 96 (IQR: 61-158) h. Pocket hematomas occurred in 9 (2.20%) patients on dabigatran and 8 (3.98%) patients on warfarin (P = 0.218). The occurrence of pocket hematomas was lower with dabigatran compared with warfarin with heparin bridging (RD: -8.62%, 95% CI: -24.15 to - 0.51%, P = 0.034) but not when compared with warfarin with no bridging (P = 0.880). Ischemic stroke occurred in 2 (0.3%) patients; one in the warfarin group (without bridging) and one in the dabigatran 150 mg bid group (P = 0.735).
Conclusion:
In patients treated with dabigatran undergoing CIED surgery, interruption of dabigatran is associated with similar or lower incidence of pocket hematoma, when compared with warfarin interruption without or with heparin bridging, respectively. Whether uninterrupted dabigatran can reduce pocket hematoma or ischemic stroke remains to be evaluated.
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