Peri-Procedural Management of Direct-Acting Oral Anticoagulants (DOACs) in Transcatheter Miniaturized Leadless...

Area of Science:

• Cardiology
• Medical Devices
• Pharmacology

Background:

• Limited data exists on managing direct-acting oral anticoagulants (DOACs) during transcatheter pacing leadless system (TPS) implantations.
• Peri-operative management of DOACs requires careful consideration to balance bleeding and thromboembolic risks.
• Evaluating standardized DOAC management protocols is crucial for patient safety and procedural success.

Purpose of the Study:

• To assess a standardized DOAC management regimen for TPS implantation.
• To identify patient clinical characteristics associated with the standardized DOAC approach.
• To evaluate the safety and efficacy of peri-operative DOAC management during TPS procedures.

Main Methods:

• A retrospective study included consecutive patients undergoing TPS implantation at two Swiss tertiary centers.
• DOAC peri-operative management was categorized into a standardized approach (Group 1A) and other approaches (Group 1B).
• Standardized approach involved single-dose interruption before implantation and reinitiation within 6-24 hours.

Main Results:

• 392 patients underwent TPS implantation; 192 were on DOACs.
• The rate of major peri-procedural complications was similar between the standardized (2.6%) and other (3.8%) DOAC management groups (p=0.685).
• The standardized DOAC approach was more frequently used for elective TPS procedures in patients with better clinical status.

Conclusions:

• Standardized peri-operative DOAC management for TPS implantation is feasible and safe.
• This protocol did not appear to increase the risk of bleeding or thromboembolic adverse events.
• The standardized approach was associated with elective procedures and patients in better overall clinical condition.