UCL Discovery
UCL home » Library Services » Electronic resources » UCL Discovery

Non-vitamin K oral anticoagulants at the time of cardiac rhythm device surgery: A systematic review and meta-analysis

Creta, A; Finlay, M; Hunter, RJ; Chow, A; Sporton, S; Muthumala, A; Dhillon, G; ... Providência, R; + view all (2020) Non-vitamin K oral anticoagulants at the time of cardiac rhythm device surgery: A systematic review and meta-analysis. Thrombosis Research , 188 pp. 90-96. 10.1016/j.thromres.2020.02.007. Green open access

[img]
Preview
Text
Lambiase_16 06 2019 noac device review.pdf - Accepted version

Download (963kB) | Preview

Abstract

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.

Type: Article
Title: Non-vitamin K oral anticoagulants at the time of cardiac rhythm device surgery: A systematic review and meta-analysis
Open access status: An open access version is available from UCL Discovery
DOI: 10.1016/j.thromres.2020.02.007
Publisher version: https://doi.org/10.1016/j.thromres.2020.02.007
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: Novel oral anticoagulants, NOAC, Pacemaker, Defibrillator, Haematoma, Bleeding
UCL classification: UCL
UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science > Clinical Science
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Health Informatics
URI: https://discovery.ucl.ac.uk/id/eprint/10097560
Downloads since deposit
11Downloads
Download activity - last month
Download activity - last 12 months
Downloads by country - last 12 months

Archive Staff Only

View Item View Item