title: Comparison of dabigatran and uninterrupted warfarin in patients with atrial fibrillation undergoing cardiac rhythm device implantations. Case-control study.
abstract: BACKGROUND
  The incidence of postoperative complications following pacemaker or implantable cardioverter-defibrillator implantations in patients treated with new oral anticoagulation agents has not been studied. Here we present a first comparison of complications after cardiac rhythm device (CRD) implantations in patients with atrial fibrillation (AF) treated with dabigatran or uninterrupted warfarin.
  
  
  RESULTS
  Using a case-control study design, we compared complications within 30 days after 236 CRD procedures performed under uninterrupted warfarin (n=118) or interrupted dabigatran (n=118).There were no significant differences in the baseline characteristics of both groups. In the warfarin group, 9 (8%) pocket hematomas were observed vs. 3 (3%) in the dabigatran group (P=0.075). Two complications in the warfarin group necessitated surgical intervention as opposed to none in the dabigatran group (P=0.156). The postprocedural blood loss expressed as a drop in hemoglobin was significantly greater in the warfarin group (-0.9±0.7 vs. -0.5±0.4 mmol/L, P=0.023). In the dabigatran group, 1 case of transient ischemic attack occurred. The mean time to hospital discharge was shorter in patients treated with dabigatran (2.5±2.3 vs. 3.8±4.1 days, P=0.02).
  
  
  CONCLUSIONS
  The incidence and severity of bleeding complications may be lower in patients treated with periprocedurally discontinued dabigatran when compared with uninterrupted warfarin therapy. Further evaluation of peri-interventional complications and establishment of an optimal anticoagulation management protocol are needed.
authors.affiliation: Department of Electrophysiology, Heart Center Leipzig.
authors.forename: Jedrzej
authors.initials: J
authors.lastname: Kosiuk
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Koutalas
authors.forename: Michael
authors.initials: M
authors.lastname: Doering
authors.forename: Sotirios
authors.initials: S
authors.lastname: Nedios
authors.forename: Philipp
authors.initials: P
authors.lastname: Sommer
authors.forename: Sascha
authors.initials: S
authors.lastname: Rolf
authors.forename: Angeliki
authors.initials: A
authors.lastname: Darma
authors.forename: Ole A
authors.initials: OA
authors.lastname: Breithardt
authors.forename: Borislav
authors.initials: B
authors.lastname: Dinov
authors.forename: Gerhard
authors.initials: G
authors.lastname: Hindricks
authors.forename: Sergio
authors.initials: S
authors.lastname: Richter
authors.forename: Andreas
authors.initials: A
authors.lastname: Bollmann
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000991:Antithrombins / Q000008:administration & dosage / Q000009:adverse effects; D001281:Atrial Fibrillation / Q000097:blood / Q000453:epidemiology* / Q000628:therapy*; D001562:Benzimidazoles / Q000008:administration & dosage / Q000009:adverse effects; D016022:Case-Control Studies; D000069604:Dabigatran; D005260:Female; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D019106:Postoperative Hemorrhage / Q000097:blood / Q000139:chemically induced / Q000453:epidemiology*; D011446:Prospective Studies; D014859:Warfarin / Q000008:administration & dosage / Q000009:adverse effects; D015091:beta-Alanine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*
chemical_list: D000991:Antithrombins; D001562:Benzimidazoles; D006454:Hemoglobins; D015091:beta-Alanine; D014859:Warfarin; D000069604:Dabigatran