Key result
Periprocedurally interrupted dabigatran was associated with a 3% rate of pocket hematomas compared to 8% with uninterrupted warfarin in patients undergoing cardiac rhythm device implantation (P=0.075).
Why the study?
Does interrupted dabigatran reduce bleeding complications compared to uninterrupted warfarin in patients with atrial fibrillation undergoing cardiac rhythm device implantations?
Case-Control (n=236)
No
Does interrupted dabigatran reduce bleeding complications compared to uninterrupted warfarin in patients with atrial fibrillation undergoing cardiac rhythm device implantations?
Absolute Event Rate: 3% vs 8%
p-value: p=0.075
Periprocedural interruption of dabigatran appears safe and may reduce bleeding complications and hospital stay compared to uninterrupted warfarin during cardiac rhythm device implantation.
May support interrupted dabigatran to limit pocket hematomas in device implantation; hypothesis-generating and requires randomized confirmation.
BACKGROUND: The incidence of postoperative complications following pacemaker or implantable cardioverter-defibrillator implantations in patients treated with new oral anticoagulation agents has not been studied. Here we present a first comparison of complications after cardiac rhythm device (CRD) implantations in patients with atrial fibrillation (AF) treated with dabigatran or uninterrupted warfarin. METHODS AND RESULTS: Using a case-control study design, we compared complications within 30 days after 236 CRD procedures performed under uninterrupted warfarin (n=118) or interrupted dabigatran (n=118).There were no significant differences in the baseline characteristics of both groups. In the warfarin group, 9 (8%) pocket hematomas were observed vs. 3 (3%) in the dabigatran group (P=0.075). Two complications in the warfarin group necessitated surgical intervention as opposed to none in the dabigatran group (P=0.156). The postprocedural blood loss expressed as a drop in hemoglobin was significantly greater in the warfarin group (-0.9±0.7 vs. -0.5±0.4 mmol/L, P=0.023). In the dabigatran group, 1 case of transient ischemic attack occurred. The mean time to hospital discharge was shorter in patients treated with dabigatran (2.5±2.3 vs. 3.8±4.1 days, P=0.02). CONCLUSIONS: The incidence and severity of bleeding complications may be lower in patients treated with periprocedurally discontinued dabigatran when compared with uninterrupted warfarin therapy. Further evaluation of peri-interventional complications and establishment of an optimal anticoagulation management protocol are needed.
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Kosiuk et al. (2014) conducted a case-control in Atrial Fibrillation undergoing Cardiac Rhythm Device Implantation (n=236). Interrupted dabigatran vs. Uninterrupted warfarin was evaluated on Pocket hematomas within 30 days (p=0.075). Periprocedurally interrupted dabigatran was associated with a 3% rate of pocket hematomas compared to 8% with uninterrupted warfarin in patients undergoing cardiac rhythm device implantation (P=0.075).
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