Division of Cardiac Electrophysiology, Prairie Heart Institute, Springfield, Illinois, USA.
Internal Medicine, Georgetown University Medical Center, Washington, District of Columbia, USA.
J Cardiovasc Electrophysiol. 2021 Oct;32(10):2722-2728. doi: 10.1111/jce.15192. Epub 2021 Aug 4.
Direct oral anticoagulants (DOACs) have increasingly been used for several indications for systemic anticoagulation in patients with cardiac implantable electronic devices (CIEDs). The optimal management of anticoagulation therapy in patients undergoing transvenous lead extraction (TLE) procedures remains uncertain.
The aim of this study was to evaluate the feasibility and safety of TLE during minimally interrupted DOAC therapy.
This is a single-center retrospective study of all patients who underwent TLE of a pacemaker or implantable cardioverter-defibrillator lead while on DOAC therapy. In patients deemed to be at high thromboembolic risk, the last DOAC dose was administered the morning of the day before the procedure (regardless of the type of DOAC) and was restarted as soon as possible after the procedure, without bridging with parenteral anticoagulation.
During the study period, a total of 84 patients underwent TLE while on minimally interrupted DOAC therapy (54% female, mean age: 74 ± 12 years). TLE was attempted for 161 leads, with a median lead dwell time of 61 months (interquartile range, 38-101). Complete procedural success was achieved for 156 leads (96.9%) and partial success for additional two leads (1.2%). One patient developed RV perforation and required pericardiocentesis and blood transfusion, but no surgical repair. Two patients developed pocket hematomas requiring invasive evacuation. No systemic or venous thromboembolic events were observed. There was no in-hospital mortality.
In selected CIED patients at high risk for thromboembolism, TLE during minimally interrupted DOAC therapy may be considered when performed at experienced centers.
直接口服抗凝剂（DOAC）越来越多地用于心脏植入式电子设备（CIED）患者的多种全身性抗凝指征。在接受经静脉导线拔除（TLE）手术的患者中，最佳的抗凝治疗管理仍不确定。
本研究旨在评估在 DOAC 治疗中最小中断的情况下进行 TLE 的可行性和安全性。
这是一项单中心回顾性研究，纳入了所有正在接受 DOAC 治疗并同时进行起搏器或植入式心律转复除颤器导线 TLE 的患者。对于被认为具有高血栓栓塞风险的患者，最后一次 DOAC 剂量于手术前一天早晨给予（无论 DOAC 类型如何），并在手术后尽快重新开始使用，无需使用静脉内抗凝进行桥接。
在研究期间，共有 84 名患者在最小中断 DOAC 治疗的情况下接受了 TLE（54%为女性，平均年龄：74±12 岁）。尝试拔除了 161 根导线，中位导线留置时间为 61 个月（四分位间距，38-101）。156 根导线获得了完全手术成功，另外两根导线获得了部分成功（1.2%）。1 名患者发生 RV 穿孔，需要进行心包穿刺和输血，但无需手术修复。2 名患者发生囊袋血肿，需要进行侵入性清除。未观察到全身性或静脉血栓栓塞事件。无院内死亡。
在具有高血栓栓塞风险的选定 CIED 患者中，在经验丰富的中心进行时，在最小中断 DOAC 治疗期间进行 TLE 可能是可以考虑的。
