title: Cardiovascular implantable electronic device implantation with uninterrupted dabigatran: comparison to uninterrupted warfarin.
abstract: BACKGROUND
  While continuation of oral anticoagulation (OAC) with warfarin may be preferable to interruption and bridging with heparin for patients undergoing cardiovascular implantable electronic device (CIED) implantation, it is uncertain whether the same strategy can be safely used with dabigatran.
  
  
  OBJECTIVE
  To determine the risk of bleeding and thromboembolic complications associated with uninterrupted OAC during CIED implantation, replacement, or revision, the outcomes of patients receiving uninterrupted dabigatran (D) were compared to those receiving warfarin (W).
  
  
  RESULTS
  D was administered the day of CIED implant in 48 patients (age 66 ± 12.4 years, 13 F and 35 M, 21 ICDs and 27 PMs), including new implant in 25 patients, replacement in 14 patients, and replacement plus lead revision in 9 patients. D was held the morning of the procedure in 14 patients (age 70 ± 11 years, 4 F and 10 M, 5 ICDs and 9 PMs). W was continued in 195 patients (age 60 ± 14.4 years, 54 F, and 141 M), including new implant in 122 patients, replacement in 33 patients, and replacement plus lead revision or upgrade in 40 patients. Bleeding complications occurred in 1 of 48 patients (2.1%) with uninterrupted dabigatran (a late pericardial effusion), 0 of 14 with interrupted D, and 9 of 195 patients (4.6%) on W (9 pocket hematomas), P = 0.69. Fifty percent of bleeding complications were associated with concomitant antiplatelet medications.
  
  
  CONCLUSIONS
  The incidence of bleeding complications is similar during CIED implantation with uninterrupted D or W. The risks are higher when OAC is combined with antiplatelet drugs.
authors.affiliation: University of Alabama at Birmingham, Birmingham, Alabama, USA.
authors.forename: John M
authors.initials: JM
authors.lastname: Jennings
authors.forename: Robert
authors.initials: R
authors.lastname: Robichaux
authors.forename: H Thomas
authors.initials: HT
authors.lastname: McElderry
authors.forename: Vance J
authors.initials: VJ
authors.lastname: Plumb
authors.forename: Alicia
authors.initials: A
authors.lastname: Gunter
authors.forename: Harish
authors.initials: H
authors.lastname: Doppalapudi
authors.forename: Jose
authors.initials: J
authors.lastname: Osorio
authors.forename: Takumi
authors.initials: T
authors.lastname: Yamada
authors.forename: G Neal
authors.initials: GN
authors.lastname: Kay
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D001562:Benzimidazoles / Q000008:administration & dosage* / Q000009:adverse effects; D002304:Cardiac Pacing, Artificial / Q000009:adverse effects; D000069604:Dabigatran; D017147:Defibrillators, Implantable; D020878:Device Removal / Q000009:adverse effects; D004334:Drug Administration Schedule; D004554:Electric Countershock / Q000009:adverse effects / Q000295:instrumentation*; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects; D019919:Prosthesis Implantation / Q000009:adverse effects; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014859:Warfarin / Q000008:administration & dosage* / Q000009:adverse effects; D015091:beta-Alanine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*
chemical_list: D000925:Anticoagulants; D001562:Benzimidazoles; D010975:Platelet Aggregation Inhibitors; D015091:beta-Alanine; D014859:Warfarin; D000069604:Dabigatran
keywords: cardiovascular implantable electronic device (CIED); dabigatran; implantable cardioverter defibrillator; pacemaker; warfarin