Short-term dabigatran interruption before cardiac rhythm device implantation: multi-centre experience from the RE-LY trial.
OBJECTIVE
Cardiac implantable electronic device (CIED) surgery is commonly performed in patients with atrial fibrillation (AF). The current analysis was undertaken to compare peri-operative anticoagulation management, bleeding, and thrombotic events in AF patients treated with dabigatran vs. warfarin.


RESULTS
This study included 611 patients treated with dabigatran vs. warfarin who underwent CIED surgery during the RE-LY trial. Among 201 warfarin-treated patients, warfarin was interrupted a median of 144 (inter-quartile range, IQR: 120-216) h, and 37 (18.4%) patients underwent heparin bridging. In dabigatran-treated patients (216 on 110 mg bid and 194 on 150 mg bid), the duration of dabigatran interruption was a median of 96 (IQR: 61-158) h. Pocket hematomas occurred in 9 (2.20%) patients on dabigatran and 8 (3.98%) patients on warfarin (P = 0.218). The occurrence of pocket hematomas was lower with dabigatran compared with warfarin with heparin bridging (RD: -8.62%, 95% CI: -24.15 to - 0.51%, P = 0.034) but not when compared with warfarin with no bridging (P = 0.880). Ischemic stroke occurred in 2 (0.3%) patients; one in the warfarin group (without bridging) and one in the dabigatran 150 mg bid group (P = 0.735).


CONCLUSIONS
In patients treated with dabigatran undergoing CIED surgery, interruption of dabigatran is associated with similar or lower incidence of pocket hematoma, when compared with warfarin interruption without or with heparin bridging, respectively. Whether uninterrupted dabigatran can reduce pocket hematoma or ischemic stroke remains to be evaluated.
McGill University Health Center, 1650 Cedar Ave, Room E5-200, Montreal, QC, Canada H3G 1A4.|Hôpital Sacré-Coeur de Montréal, Montreal, QC, Canada.
Vidal
V
Essebag
Cardiology Department, Morriston Hospital, Swansea University, Heol Maes Eglwys, Morriston, Swansea SA6 6NL, UK.|Cardiology Department, Luigi Sacco Hospital, Milan, Italy.
Riccardo
R
Proietti
University of Ottawa Heart Institute, Ottawa, ON, Canada.
David H
DH
Birnie
Population Health Research Institute, McMaster University, Hamilton, ON, Canada.
Jia
J
Wang
St. Joseph's Healthcare, Department of Medicine, McMaster University, Hamilton, ON, Canada.
James
J
Douketis
Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada.
Benoit
B
Coutu
Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada.
Ratika
R
Parkash
University of Birmingham Institute of Cardiovascular Sciences, City Hospital, Birmingham, UK.
Gregory Y H
GYH
Lip
Klinikum der Johann-Wolfgang-Goethe Universität, Frankfurt, Germany.
Stefan H
SH
Hohnloser
Craigavon Area Hospital, Portadown, ARM, Northern Ireland.
Andrew
A
Moriarty
Uppsala Clinical Research Center and Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden.
Jonas
J
Oldgren
Population Health Research Institute, McMaster University, Hamilton, ON, Canada.
Stuart J
SJ
Connolly
Thomas Jefferson Medical College and the Heart Center, Wynnewood, PA, USA.
Michael
M
Ezekowitz
Population Health Research Institute, McMaster University, Hamilton, ON, Canada.
Jeff S
JS
Healey
D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D000991:Antithrombins / Q000008:administration & dosage* / Q000009:adverse effects; D001281:Atrial Fibrillation / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D000069604:Dabigatran / Q000008:administration & dosage* / Q000009:adverse effects; D017147:Defibrillators, Implantable; D004334:Drug Administration Schedule; D057915:Drug Substitution; D005260:Female; D006406:Hematoma / Q000139:chemically induced; D006470:Hemorrhage / Q000139:chemically induced; D006493:Heparin / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D019919:Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D013927:Thrombosis / Q000209:etiology / Q000517:prevention & control; D013997:Time Factors; D016896:Treatment Outcome; D014859:Warfarin / Q000008:administration & dosage* / Q000009:adverse effects
D000925:Anticoagulants; D000991:Antithrombins; D014859:Warfarin; D006493:Heparin; D000069604:Dabigatran
Anticoagulation; Dabigatran; Device implantation; Hematoma; Warfarin