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Pocket hematoma after pacemaker or defibrillator surgery: Direct oral anticoagulants versus vitamin K antagonists

John de Heide1, Marisa van der Graaf1, Marijn J Holl1

  • 1Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands. All authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.

International Journal of Cardiology. Heart & Vasculature
|March 21, 2022
PubMed

Insights

Direct oral anticoagulants (DOACs) and vitamin K antagonists (VKAs) show similar low risks for pocket hematoma and thromboembolic events in atrial fibrillation (AF) patients undergoing cardiac implantable electronic device (CIED) procedures. Interrupted DOAC or continued VKA regimens are safe options.

Area of Science:

  • Cardiology
  • Pharmacology
  • Medical Devices

Background:

  • Direct oral anticoagulants (DOACs) are preferred for atrial fibrillation (AF) anticoagulation.
  • Real-world data on DOACs in patients undergoing cardiac implantable electronic device (CIED) procedures is limited.
  • Previous randomized trials suggest DOACs are safe and effective in this setting.

Purpose of the Study:

  • To compare outcomes of interrupted DOAC versus continued vitamin K antagonist (VKA) regimens in AF patients undergoing elective CIED procedures.
  • To evaluate the incidence of pocket hematoma and thromboembolic complications.
  • To provide real-world evidence on anticoagulation management during CIED procedures.

Main Methods:

  • Retrospective single-center study of 283 AF patients undergoing elective CIED procedures (January 2016 - June 2019).
  • Patients were on either interrupted DOAC (N=81) or continued VKA (N=202) oral anticoagulation.
  • Primary endpoint: clinically significant pocket hematoma within 30 days. Secondary endpoint: systemic thromboembolic complications within 30 days.

Main Results:

  • No significant difference in pocket hematoma rates between VKA (2.5%) and DOAC (0%) groups (P=0.33).
  • No thromboembolic events were reported in either group.
  • DOAC group was younger, had less renal disease, more paroxysmal AF, and lower HAS-BLED scores.

Conclusions:

  • Interrupted DOAC and continued VKA regimens are associated with comparably low risks of pocket hematoma and systemic thromboembolic events in AF patients undergoing elective CIED procedures.
  • This real-world data supports the safety of both anticoagulation strategies.
  • Further research may explore optimal management in specific patient subgroups.
Abstract

Keywords:
Atrial fibrillationBleedingDirect oral anticoagulantImplantable cardioverter defibrillatorPacemakernon-vitamin K antagonist

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