Andrea Di Cori1, Angelo Auricchio2, François Regoli2, Carina Blomström-Lundqvist3, Christian Butter4, Nikolaos Dagres5, Jean-Claude Deharo6, Aldo P Maggioni7,8, Andrzej Kutarski9, Charles Kennergren10, Cécile Laroche7, Christopher A Rinaldi11, Emilio Vincenzo Dovellini12, Pier Giorgio Golzio13, Anna Margrethe Thøgersen14, Maria Grazia Bongiorni1. 1. Second Division of Cardiology, Department of Cardiac-Thoracic & Vascular, Azienda Ospedaliera Pisana, Via Paradisa 2, Pisa, Italy. 2. Fondazione Cardiocentro Ticino, Via Tesserete 48, Lugano, Italy. 3. Department of Medical Science and Cardiology, Uppsala University, Uppsala, Sweden. 4. Department of Cardiology, Heart Center Brandenburg in Bernau/Berlin & Brandenburg Medical School, Ladeburger Straße 17, Bernau, Germany. 5. Department of Electrophysiology, Heart Center Leipzig, Germany. 6. CHU La Timone, Cardiologie, Service du prof Deharo, 264 Rue Saint Pierre, Marseille, France. 7. EURObservational Research Programme (EORP), European Society of Cardiology, 2035 routes des Colles, Sophia Antipolis, France. 8. ANMCO Research Center, Florence, Italy. 9. Department of Cardiology, Medical University of Lublin, Jaczerskiego Street Nr 8, Lublin, Poland. 10. Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Sahlgrenska/SU, Goteborg, Sweden. 11. St Thomas Hospital, Westminster Bridge Road, London, UK. 12. Department of Interventional Cardiology, Cardiothoracic and Vascular, Careggi University Hospital, Florence, Italy. 13. Division of Cardiology, Department of Internal Medicine, A.O.U. Citta della Salute e della Scienza di Torino Molinette, Corso Bramente 88, Torino, Italy. 14. Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.
Abstract
AIMS: A sub-analysis of the ESC-EHRA European Lead Extraction ConTRolled (ELECTRa) Registry to evaluate the clinical impact of antithrombotic (AT) on transvenous lead extraction (TLE) safety and efficacy. METHODS AND RESULTS: ELECTRa outcomes were compared between patients without AT therapy (No AT Group) and with different pre-operative AT regimens, including antiplatelets (AP), anticoagulants (AC), or both (AP + AC). Out of 3510 pts, 2398 (68%) were under AT pre-operatively. AT patients were older with more comorbidities (P < 0.0001). AT subgroups, defined as AP, AC, or AP + AC, were 1096 (31.2%), 985 (28%), and 317 (9%), respectively. Regarding AP patients, 1413 (40%) were under AP, 1292 (91%) with a single AP, interrupted in 26% about 3.8 ± 3.7 days before TLE. In total, 1302 (37%) patients were under AC, 881 vitamin K antagonist (68%), 221 (17%) direct oral anticoagulants, 155 (12%) low weight molecular heparin, and 45 (3.5%) unfractionated heparin. AC was 'interrupted without bridging' in 696 (54%) and 'interrupted with bridging' in 504 (39%) about 3.3 ± 2.3 days before TLE, and 'continued' in 87 (7%). TLE success rate was high in all subgroups. Only overall in-hospital death (1.4%), but not the procedure-related one, was higher in the AT subgroups (P = 0.0500). Age >65 years and New York Heart Association Class III/IV, but not AT regimens, were independent predictors of death for any cause. Haematomas were more frequent in AT subgroups, especially in AC 'continued' (P = 0.025), whereas pulmonary embolism in the No-AT (P < 0.01). CONCLUSIONS: AT minimization is safe in patients undergoing TLE. AT does not seem to predict death but identifies a subset of fragile patients with a worse in-hospital TLE outcome. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: A sub-analysis of the ESC-EHRA European Lead Extraction ConTRolled (ELECTRa) Registry to evaluate the clinical impact of antithrombotic (AT) on transvenous lead extraction (TLE) safety and efficacy. METHODS AND RESULTS: ELECTRa outcomes were compared between patients without AT therapy (No AT Group) and with different pre-operative AT regimens, including antiplatelets (AP), anticoagulants (AC), or both (AP + AC). Out of 3510 pts, 2398 (68%) were under AT pre-operatively. AT patients were older with more comorbidities (P < 0.0001). AT subgroups, defined as AP, AC, or AP + AC, were 1096 (31.2%), 985 (28%), and 317 (9%), respectively. Regarding AP patients, 1413 (40%) were under AP, 1292 (91%) with a single AP, interrupted in 26% about 3.8 ± 3.7 days before TLE. In total, 1302 (37%) patients were under AC, 881 vitamin K antagonist (68%), 221 (17%) direct oral anticoagulants, 155 (12%) low weight molecular heparin, and 45 (3.5%) unfractionated heparin. AC was 'interrupted without bridging' in 696 (54%) and 'interrupted with bridging' in 504 (39%) about 3.3 ± 2.3 days before TLE, and 'continued' in 87 (7%). TLE success rate was high in all subgroups. Only overall in-hospital death (1.4%), but not the procedure-related one, was higher in the AT subgroups (P = 0.0500). Age >65 years and New York Heart Association Class III/IV, but not AT regimens, were independent predictors of death for any cause. Haematomas were more frequent in AT subgroups, especially in AC 'continued' (P = 0.025), whereas pulmonary embolism in the No-AT (P < 0.01). CONCLUSIONS: AT minimization is safe in patients undergoing TLE. AT does not seem to predict death but identifies a subset of fragilepatients with a worse in-hospital TLE outcome. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Paweł Stefańczyk; Dorota Nowosielecka; Łukasz Tułecki; Konrad Tomków; Anna Polewczyk; Wojciech Jacheć; Andrzej Kleinrok; Wojciech Borzęcki; Andrzej Kutarski Journal: Vasc Health Risk Manag Date: 2021-08-05