Pulmonary vascular disease & thromboembolism
Direct Oral Anticoagulants (DOACs) vs Vitamin K Antagonists During Cardiac Rhythm Device Surgery: A Multicenter Propensity-Matched Study
Authors' conclusion
In this large real-world cohort, a continued DOAC strategy was associated with a higher bleeding risk compared to DOAC interruption or VKA continuation in patients undergoing CIED surgery. However, DOAC interruption was associated with increased thromboembolic risk.
Study context
- Population
- Patients on chronic oral anticoagulation undergoing cardiac implantable electronic device (CIED) surgerymatched population 861
- Participants
- 1,975 patients
- Exposure
- Continued DOAC vs interrupted DOAC vs continued VKA during CIED surgery
- Interrupted DOACn = 1,039
- Continued DOACn = 287
- Continued VKAn = 649
- Outcome
- Device-related bleeds and thrombotic events
Methodological detailspropensity-score matched
- Propensity-score matched
Main finding
As reported in the abstract
Any major bleeding
P = 0.03
Observational data: associations, not effects.
Further findings
Independent predictors of major bleeding (multivariable analysis)
- DAPT, DOAC continuation and male sex were independent predictors of major bleeding
Safety
| Outcome | Interrupted DOAC | Continued DOAC | Continued VKA | P value |
|---|---|---|---|---|
| Perioperative thromboembolismInterrupted DOAC vs Continued DOAC and Continued VKA | 1.4% | 0 events | 0 events | P = 0.04 |
Original publication
DOACs vs Vitamin K Antagonists During Cardiac Rhythm Device Surgery: A Multicenter Propensity-Matched Study. JACC Clin Electrophysiol. Published 25 October 2023. doi:10.
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