Oral anticoagulation management in patients with atrial fibrillation undergoing cardiac implantable electronic device implantation

for the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF) Investigators

Research output: Contribution to journalArticle

Abstract

Background: Oral anticoagulation (OAC) therapy is associated with increased periprocedural risks after cardiac implantable electronic device (CIED) implantation. Patterns of anticoagulation management involving non–vitamin K antagonist oral anticoagulants (NOACs) have not been characterized. Hypothesis: Anticoagulation strategies and outcomes differ by anticoagulant type in patients undergoing CIED implantation. Methods: Using the nationwide Outcomes Registry for Better Informed Treatment of Atrial Fibrillation, we assessed how atrial fibrillation (AF) patients undergoing CIED implantation were cared for and their subsequent outcomes. Outcomes were compared by oral anticoagulant therapy (none, warfarin, or NOAC) as well as by anticoagulation interruption status. Results: Among 9129 AF patients, 416 (5%) underwent CIED implantation during a median follow-up of 30 months (interquartile range, 24–36). Of these, 60 (14%) had implantation on a NOAC. Relative to warfarin therapy, those on a NOAC were younger (70.5 years [range, 65–77.5 years] vs 77 years [range, 70–82 years]), had less valvular heart disease (15.0% vs 31.3%), higher creatinine clearance (67.3 [range, 59.7–99.0] vs 65.8 [range, 50.0–91.6]), were more likely to have persistent AF (26.7% vs 22.9%), and use concomitant aspirin (51.7% vs 35.2%). OAC therapy was commonly interrupted for CIED in 64% (n = 183 of 284) of warfarin patients and 65% (n = 39 of 60) of NOAC patients. Many interrupted patients received intravenous bridging anticoagulation: 33/183 (18%) interrupted warfarin and 4/39 (10%) interrupted NOAC patients. Thirty-day periprocedure bleeding and stroke adverse events were infrequent. Conclusions: Management of anticoagulation among AF patients undergoing CIED implantation is highly variable, with OAC being interrupted in more than half of both warfarin- and NOAC-treated patients. Bleeding and stroke events were infrequent in both warfarin and NOAC-treated patients.

Original languageEnglish (US)
Pages (from-to)746-751
Number of pages6
JournalClinical Cardiology
Volume40
Issue number9
DOIs
StatePublished - Sep 2017

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Anticoagulants
Atrial Fibrillation
Warfarin
Equipment and Supplies
Stroke
Hemorrhage
Therapeutics
Heart Valve Diseases
Aspirin
Registries
Creatinine

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

for the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF) Investigators (2017). Oral anticoagulation management in patients with atrial fibrillation undergoing cardiac implantable electronic device implantation. Clinical Cardiology, 40(9), 746-751. https://doi.org/10.1002/clc.22726
for the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF) Investigators. / Oral anticoagulation management in patients with atrial fibrillation undergoing cardiac implantable electronic device implantation. In: Clinical Cardiology. 2017 ; Vol. 40, No. 9. pp. 746-751.
@article{c8d58d85769141af87e5d5d85731711d,
title = "Oral anticoagulation management in patients with atrial fibrillation undergoing cardiac implantable electronic device implantation",
abstract = "Background: Oral anticoagulation (OAC) therapy is associated with increased periprocedural risks after cardiac implantable electronic device (CIED) implantation. Patterns of anticoagulation management involving non–vitamin K antagonist oral anticoagulants (NOACs) have not been characterized. Hypothesis: Anticoagulation strategies and outcomes differ by anticoagulant type in patients undergoing CIED implantation. Methods: Using the nationwide Outcomes Registry for Better Informed Treatment of Atrial Fibrillation, we assessed how atrial fibrillation (AF) patients undergoing CIED implantation were cared for and their subsequent outcomes. Outcomes were compared by oral anticoagulant therapy (none, warfarin, or NOAC) as well as by anticoagulation interruption status. Results: Among 9129 AF patients, 416 (5{\%}) underwent CIED implantation during a median follow-up of 30 months (interquartile range, 24–36). Of these, 60 (14{\%}) had implantation on a NOAC. Relative to warfarin therapy, those on a NOAC were younger (70.5 years [range, 65–77.5 years] vs 77 years [range, 70–82 years]), had less valvular heart disease (15.0{\%} vs 31.3{\%}), higher creatinine clearance (67.3 [range, 59.7–99.0] vs 65.8 [range, 50.0–91.6]), were more likely to have persistent AF (26.7{\%} vs 22.9{\%}), and use concomitant aspirin (51.7{\%} vs 35.2{\%}). OAC therapy was commonly interrupted for CIED in 64{\%} (n = 183 of 284) of warfarin patients and 65{\%} (n = 39 of 60) of NOAC patients. Many interrupted patients received intravenous bridging anticoagulation: 33/183 (18{\%}) interrupted warfarin and 4/39 (10{\%}) interrupted NOAC patients. Thirty-day periprocedure bleeding and stroke adverse events were infrequent. Conclusions: Management of anticoagulation among AF patients undergoing CIED implantation is highly variable, with OAC being interrupted in more than half of both warfarin- and NOAC-treated patients. Bleeding and stroke events were infrequent in both warfarin and NOAC-treated patients.",
author = "{for the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF) Investigators} and Eric Black-Maier and Sunghee Kim and Steinberg, {Benjamin A.} and Fonarow, {Gregg C.} and Freeman, {James V.} and Kowey, {Peter R.} and Jack Ansell and Gersh, {Bernard J.} and Mahaffey, {Kenneth W.} and Gerald Naccarelli and Hylek, {Elaine M.} and Go, {Alan S.} and Peterson, {Eric D.} and Piccini, {Jonathan P.}",
year = "2017",
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for the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF) Investigators 2017, 'Oral anticoagulation management in patients with atrial fibrillation undergoing cardiac implantable electronic device implantation', Clinical Cardiology, vol. 40, no. 9, pp. 746-751. https://doi.org/10.1002/clc.22726

Oral anticoagulation management in patients with atrial fibrillation undergoing cardiac implantable electronic device implantation. / for the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF) Investigators.

In: Clinical Cardiology, Vol. 40, No. 9, 09.2017, p. 746-751.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Oral anticoagulation management in patients with atrial fibrillation undergoing cardiac implantable electronic device implantation

AU - for the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF) Investigators

AU - Black-Maier, Eric

AU - Kim, Sunghee

AU - Steinberg, Benjamin A.

AU - Fonarow, Gregg C.

AU - Freeman, James V.

AU - Kowey, Peter R.

AU - Ansell, Jack

AU - Gersh, Bernard J.

AU - Mahaffey, Kenneth W.

AU - Naccarelli, Gerald

AU - Hylek, Elaine M.

AU - Go, Alan S.

AU - Peterson, Eric D.

AU - Piccini, Jonathan P.

PY - 2017/9

Y1 - 2017/9

N2 - Background: Oral anticoagulation (OAC) therapy is associated with increased periprocedural risks after cardiac implantable electronic device (CIED) implantation. Patterns of anticoagulation management involving non–vitamin K antagonist oral anticoagulants (NOACs) have not been characterized. Hypothesis: Anticoagulation strategies and outcomes differ by anticoagulant type in patients undergoing CIED implantation. Methods: Using the nationwide Outcomes Registry for Better Informed Treatment of Atrial Fibrillation, we assessed how atrial fibrillation (AF) patients undergoing CIED implantation were cared for and their subsequent outcomes. Outcomes were compared by oral anticoagulant therapy (none, warfarin, or NOAC) as well as by anticoagulation interruption status. Results: Among 9129 AF patients, 416 (5%) underwent CIED implantation during a median follow-up of 30 months (interquartile range, 24–36). Of these, 60 (14%) had implantation on a NOAC. Relative to warfarin therapy, those on a NOAC were younger (70.5 years [range, 65–77.5 years] vs 77 years [range, 70–82 years]), had less valvular heart disease (15.0% vs 31.3%), higher creatinine clearance (67.3 [range, 59.7–99.0] vs 65.8 [range, 50.0–91.6]), were more likely to have persistent AF (26.7% vs 22.9%), and use concomitant aspirin (51.7% vs 35.2%). OAC therapy was commonly interrupted for CIED in 64% (n = 183 of 284) of warfarin patients and 65% (n = 39 of 60) of NOAC patients. Many interrupted patients received intravenous bridging anticoagulation: 33/183 (18%) interrupted warfarin and 4/39 (10%) interrupted NOAC patients. Thirty-day periprocedure bleeding and stroke adverse events were infrequent. Conclusions: Management of anticoagulation among AF patients undergoing CIED implantation is highly variable, with OAC being interrupted in more than half of both warfarin- and NOAC-treated patients. Bleeding and stroke events were infrequent in both warfarin and NOAC-treated patients.

AB - Background: Oral anticoagulation (OAC) therapy is associated with increased periprocedural risks after cardiac implantable electronic device (CIED) implantation. Patterns of anticoagulation management involving non–vitamin K antagonist oral anticoagulants (NOACs) have not been characterized. Hypothesis: Anticoagulation strategies and outcomes differ by anticoagulant type in patients undergoing CIED implantation. Methods: Using the nationwide Outcomes Registry for Better Informed Treatment of Atrial Fibrillation, we assessed how atrial fibrillation (AF) patients undergoing CIED implantation were cared for and their subsequent outcomes. Outcomes were compared by oral anticoagulant therapy (none, warfarin, or NOAC) as well as by anticoagulation interruption status. Results: Among 9129 AF patients, 416 (5%) underwent CIED implantation during a median follow-up of 30 months (interquartile range, 24–36). Of these, 60 (14%) had implantation on a NOAC. Relative to warfarin therapy, those on a NOAC were younger (70.5 years [range, 65–77.5 years] vs 77 years [range, 70–82 years]), had less valvular heart disease (15.0% vs 31.3%), higher creatinine clearance (67.3 [range, 59.7–99.0] vs 65.8 [range, 50.0–91.6]), were more likely to have persistent AF (26.7% vs 22.9%), and use concomitant aspirin (51.7% vs 35.2%). OAC therapy was commonly interrupted for CIED in 64% (n = 183 of 284) of warfarin patients and 65% (n = 39 of 60) of NOAC patients. Many interrupted patients received intravenous bridging anticoagulation: 33/183 (18%) interrupted warfarin and 4/39 (10%) interrupted NOAC patients. Thirty-day periprocedure bleeding and stroke adverse events were infrequent. Conclusions: Management of anticoagulation among AF patients undergoing CIED implantation is highly variable, with OAC being interrupted in more than half of both warfarin- and NOAC-treated patients. Bleeding and stroke events were infrequent in both warfarin and NOAC-treated patients.

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DO - 10.1002/clc.22726

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for the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF) Investigators. Oral anticoagulation management in patients with atrial fibrillation undergoing cardiac implantable electronic device implantation. Clinical Cardiology. 2017 Sep;40(9):746-751. https://doi.org/10.1002/clc.22726