Regoli François Diederik, Saguner Ardan M, Auricchio Angelo, Demarchi Andrea, Pasotti Elena, Conte Giulio, Caputo Maria Luce, Özkartal Tardu, Breitenstein Alexander
Service of Cardiology, Hospital of San Giovanni, Cardiocentro Ticino Institute, 6500 Bellinzona, Switzerland.
Cardiology Department, Cardiocentro Ticino Institute, 6900 Lugano, Switzerland.
J Clin Med. 2023 Jul 21;12(14):4814. doi: 10.3390/jcm12144814.
Data on peri-operative management of direct-acting oral anticoagulants (DOACs) during transcatheter pacing leadless system (TPS) implantations remain limited. This study aimed to evaluate a standardized DOAC management regime consisting of interruption of a single dose prior to implantation and reinitiation within 6-24 h; also, patient clinical characteristics associated with this approach were identified.
Consecutive patients undergoing standard TPS implantation procedures from two Swiss tertiary centers were included. DOAC peri-operative management included the standardized approach (Group 1A) or other approaches (Group 1B).
Three hundred and ninety-two pts (mean age 81.4 ± 7.3 years, 66.3% male, left ventricular ejection fraction 55.5 ± 9.6%) underwent TPS implantation. Two hundred and eighty-two pts (71.9%) were under anticoagulation therapy; 192 pts were treated with DOAC; 90 pts were under vitamin-K antagonist. Patients treated with DOAC less often had structural heart disease, diabetes mellitus, and advanced renal failure. The rate of major peri-procedural complications did not differ between groups 1A ( = 115) and 1B ( = 77) (2.6% and 3.8%, = 0.685). Compared to 1B, 1A patients were implanted with TPS for slow ventricular rate atrial fibrillation (AF) ( = 0.002), in a better overall clinical status, and implanted electively (<0.001).
Standardized peri-procedural DOAC management was more often implemented for elective TPS procedures and did not seem to increase bleeding or thromboembolic adverse events.
关于经导管无导线起搏系统（TPS）植入术中直接口服抗凝剂（DOAC）围手术期管理的数据仍然有限。本研究旨在评估一种标准化的DOAC管理方案，该方案包括在植入前中断单次剂量并在6 - 24小时内重新开始用药；此外，还确定了与该方法相关的患者临床特征。
纳入了来自两个瑞士三级中心接受标准TPS植入手术的连续患者。DOAC围手术期管理包括标准化方法（1A组）或其他方法（1B组）。
392例患者（平均年龄81.4±7.3岁，男性占66.3%，左心室射血分数55.5±9.6%）接受了TPS植入。282例患者（71.9%）接受抗凝治疗；192例患者接受DOAC治疗；90例患者接受维生素K拮抗剂治疗。接受DOAC治疗的患者较少患有结构性心脏病、糖尿病和晚期肾衰竭。1A组（n = 115）和1B组（n = 77）的主要围手术期并发症发生率无差异（分别为2.6%和3.8%，P = 0.685）。与1B组相比，1A组患者因缓慢心室率心房颤动（AF）植入TPS（P = 0.002），总体临床状态更好，且为择期植入（P < 0.001）。
标准化的围手术期DOAC管理更常用于择期TPS手术，且似乎不会增加出血或血栓栓塞不良事件。
