Use of Direct Oral Anticoagulants Following Cardiac Implantable Electronic Device Placement
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View abstract on PubMed
Summary
This summary is machine-generated.Direct oral anticoagulants (DOACs) were prescribed to over half of atrial fibrillation (AF) patients after cardiac implantable electronic device (CIED) placement, with increasing use over time. While DOAC use showed slightly higher hematoma risk, it was associated with reduced stroke rates.
Area Of Science
- Cardiology
- Pharmacology
Background
- Limited data exists on direct oral anticoagulant (DOAC) use in atrial fibrillation (AF) patients undergoing cardiac implantable electronic device (CIED) placement.
- Real-world practice patterns and outcomes of uninterrupted DOAC therapy in this population are not well-defined.
Purpose Of The Study
- To describe trends in DOAC usage after uncomplicated, outpatient CIED implantation in AF patients.
- To evaluate clinical outcomes associated with DOAC status at discharge.
Main Methods
- Utilized National Cardiovascular Data Registry data for AF patients (CHA <sub>2</sub> DS <sub>2</sub> -VASc ≥ 2) undergoing uncomplicated, outpatient CIED placement (April 2016-December 2019).
- Stratified patients by DOAC prescription at discharge and assessed outcomes using Centers for Medicare and Medicaid (CMS) claims data.
Main Results
- 54.1% of 59,169 eligible AF patients were discharged on a DOAC, with annual discharge rates increasing from 47.0% (2016) to 62.5% (2019).
- DOAC use was associated with higher adjusted rates of pocket hematoma (0.51% vs. 0.33%) and lower rates of stroke (2.9% vs. 3.2%) at 30 days.
- No significant differences in device infection or revision rates at 30 days or 1 year were observed between groups.
Conclusions
- Approximately half of AF patients undergoing CIED implantation were discharged on DOACs, with increasing trends observed.
- DOAC use was linked to a modest increase in pocket hematoma and device revision rates but a similar risk of device infection.
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