TWO YEARS EXPERIENCE OF A DOSE-REDUCTION ORAL ANTICOAGULANT THERAPY PROGRAM IN PATIENTS WITH CARDIAC STIMULATION DEVICES
J.J. Ferrer Hita, A. Rodriguez-Gonzalez, R.A. Juarez-Prera, P. Machado-Machado, L.M. Perez-Hernandez,
J.M. Raya-Sanchez, A. Lara-Padron, F. Bosa-Ojeda, F. Marrero-Rodriguez, I. Laynez-Cerdena
Arrhythmia Unit, Cardiology Department and Haematology Department. Hospital Universitario de Canarias.
La Laguna, Santa Cruz de Tenerife, Spain
Introduction: our purpose was to analyze our experience after starting an oral anticoagulant therapy (OAT) dose-reduction program in patients with a cardiac stimulation devices (CSD) indication.
Methods: prospective analysis of 88 patients with OAT referred for a CSD implant/replacement. We analyzed baseline characteristics, patients’ treatment and OAT indication. We analyzed thrombotic and bleeding risk for all patients. We adjust the OAT dose for an INR the day of intervention of 1.5-2 in patients with low thrombotic risk and 2-2.5 in high risk patients. We analyzed the incidence of hemorrhagic and thrombotic complications at baseline and at 45 days.
Results: variables associated with a higher incidence of complications were high haemorrhagic risk (p=0.001), low-weight heparin use (p=0.006) and >9 french introductors use (p=0.01). Older patients, high thrombotic risk, the implantation procedures and chronic renal failure showed a slightly but non-significant increase in the degree of complications (p=0.09, 0.08, 0.06, 0.08 respectively). The rest of variables are shown in the table.
Conclusions: maintenance of OAT with dose-reduction in patients with CSD indication is a safety approach with a low risk of complications.
patients variables analyzed.
| Mean age (years) |
73,6 ± 10,6
|
| CSD Procedure
|
| Implants: 54 (60%) |
Replacement: 34 (40%) |
| - Pacemakers: 30 |
- Pacemakers: 46 |
|
- ICD-CRT: 4 |
- ICD-CRT: 8 |
| Preprocedure Thrombotic Risk
|
| High: 24% |
Moderate: 34% |
Low: 42% |
| Preprocedure Haemorrhagic Risk
|
High: 13% |
Low: 87% |
| INR at procedure day |
1,70 ± 0,38
|
| Acute haemorrhagic complications |
Mild-moderate: 11 (12%) |
Severe: 1 (1%) |
| Acute thrombotic complications |
1 (1%)
|
| Persistent later complications |
Hematoma and pocket infection: 2 (2%)
|
Table legend: CSD: cardiac stimulation devices. INR: International Normalized Ratio. ICD: implantable cardioverter-defibrillator. CRT: resynchronization device.
