Non-vitamin K oral anticoagulants at the time of cardiac rhythm device surgery: A systematic review and meta-analysis
| Autor: | Antonio Creta, Martin Lowe, Anthony Chow, Nikolaos Papageorgiou, Fakhar Khan, Germano Di Sciascio, Ross J. Hunter, Amal Muthumala, Malcolm Finlay, Francesco Grigioni, Mehul Dhinoja, Simon Sporton, Pier D. Lambiase, Danilo Ricciardi, Gurpreet Dhillon, Mahmood Ahmad, Richard J. Schilling, Peter Henry Waddingham, Rui Providência, Syed Ahsan, Mark J. Earley |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Hematoma
medicine.medical_specialty Vitamin K business.industry Incidence (epidemiology) Significant difference Administration Oral Anticoagulants Hematology 030204 cardiovascular system & hematology Vitamin k Surgery 03 medical and health sciences 0302 clinical medicine Primary outcome Thromboembolism 030220 oncology & carcinogenesis Meta-analysis Atrial Fibrillation Humans Medicine In patient business Systematic search Cohort study |
| Zdroj: | Thrombosis Research. 188:90-96 |
| ISSN: | 0049-3848 |
| DOI: | 10.1016/j.thromres.2020.02.007 |
| Popis: | Introduction Use of non-vitamin K oral anticoagulants (NOACs) has rapidly increased worldwide. We aimed to systematically assess the available evidence regarding the safety and efficacy of NOACs in patients undergoing cardiac implantable electronic device (CIED) surgery. Methods We performed a systematic literature search. Eligible randomised controlled trials and cohort studies were included. The primary outcome measures were clinically significant device-pocket haematoma and thromboembolic events. Results A total of 12 studies were included, equating to 2120 patients. The separate pooling of rate of events showed a low incidence of clinically significant device-pocket haematoma, although numerically higher in patients on continued (1.5%; CI95%0.8–3.0) versus interrupted NOAC (0.9%; CI95%0.5–1.7). The rate of any device-pocket haematoma was numerically higher in the continued versus interrupted NOAC group (5.4%; CI95%3.8–7.7 versus 2.4%; CI95%1.8–3.3). The incidence of thromboembolic events (0.4%; CI95%0.2–0.8) was low and comparable. From a meta-analysis of 3 studies (equating to 773 subjects) allowing for a comparison of continued versus interrupted NOAC, we found no significant difference between the 2 strategies in terms of clinically significant pocket haematoma (RR1.14; CI95%0.43–3.06, p = 0.79), thromboembolic complications (RR1.03; CI95%0.06–16.37, p = 0.98), and any pocket haematoma (RR1.19; CI95%0.65–2.20, p = 0.57). Conclusion Use of NOACs at the time of CIEDs surgery appears to be safe, and either strategy of peri-procedure continuation or interruption might be reasonable. However, continuation of NOAC seems to be associated with a numerically higher rate of bleeding complications. Certainty of the evidence is low, and further studies are required to confirm these findings. |
| Databáze: | OpenAIRE |
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