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Continued versus interrupted direct oral anticoagulation for cardiac electronic device implantation: A systematic

Pablo A Mendoza1, Sukrit Narula1,2, William F McIntyre1,3,2

  • 1Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.

Pacing and Clinical Electrophysiology : PACE
|October 15, 2020
PubMed

Insights

Continuing direct oral anticoagulation (DOAC) during cardiac device implantation showed no significant difference in bleeding or clotting risks compared to interruption. Interruption is generally preferred for convenience, but continuation is an option if uninterrupted anticoagulation is needed.

Area of Science:

  • Cardiology
  • Pharmacology
  • Medical Devices

Background:

  • Many patients require cardiac device implantation while on direct oral anticoagulation (DOAC).
  • Balancing bleeding risk from continuing DOAC versus thromboembolic risk from interrupting DOAC is crucial.
  • Current guidelines offer limited clarity on optimal DOAC management during these procedures.

Purpose of the Study:

  • To compare the incidence of clinically significant pocket hematoma and thromboembolism.
  • To evaluate outcomes in patients undergoing cardiac device implantation with continued versus interrupted DOAC therapy.

Main Methods:

  • Systematic search of MEDLINE, EMBASE, and CENTRAL databases up to December 2019.
  • Inclusion of randomized controlled trials (RCTs) and observational studies.
  • Meta-analysis of RCT data and quality assessment using GRADE criteria.

Main Results:

  • Two RCTs (763 patients) and three observational studies were included.
  • No significant difference in pocket hematoma (2.1% vs 1.8%) or thromboembolism (0.03% vs 0.03%) between continued and interrupted DOAC groups in RCTs.
  • Moderate quality of evidence due to imprecision; observational studies corroborated findings.

Conclusions:

  • Continuing DOACs during cardiac device implantation results in minimal difference in pocket hematoma or thromboembolic events.
  • Interrupting DOACs is often the preferred strategy due to ease of management.
  • DOAC continuation may be considered when uninterrupted anticoagulation is essential, avoiding parenteral bridging.
Abstract

Keywords:
anticoagulantsatrial fibrillationdefibrillatorshematomaperioperative care

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