Administration of oral anticoagulants in periprocedural complications based on case report series
Streszczenie
The use of dabigatran, a non-vitamin K antagonist (VKA) oral anticoagulant, is still increasing. Dabigatran has a good efficacy and safety ratio, as well as a more predictable anticoagulation effect compared with VKA. On the other hand, there is acenocoumarol/warfarin, a VKA which was evaluated in numerous clinical trials and is a drug of choice in a valve-related atrial fibrillation (AF).
Based on the real clinical cases, we attempted to summarize current recommendations on how to manage periprocedural complications on oral anticoagulant treatment.
In the first case we presented a patient on dabigatran, undergoing pulmonary vein isolation (PVI) of AF, who developed a right groin hematoma after the procedure and hence required several blood transfusions. In the second case we showed a patient on acenocoumarol, with high bleeding risk, who developed a pocket hematoma after an implantable cardioverter-defibrillator (ICD) implantation. We also reported a patient on dabigatran, who developed a femoral artery pseudoaneurysm (FAP) following PVI of AF.
Periprocedural oral anticoagulation depends on the anticoagulant type and requires individual assessment of the
patient’s thromboembolic and bleeding risk factors. Our case reports showed that in case of a bleeding, dabigatran
may be quickly stopped and then restarted recently after reaching hemostasis, in contrast to acenocoumarol. They also confirm a possibility of successful pseudoaneurysm closure without dabigatran suspension.
Słowa kluczowe: acenocoumaroldabigatranhematomaperiprocedural complicationspulmonary vein isolationimplantable cardioverter-defibrillatorpseudoaneurysm
Referencje
- Heidbuchel H, Verhamme P, Alings M, et al. Advisors:. Updated European Heart Rhythm Association Practical Guide on the use of non-vitamin K antagonist anticoagulants in patients with non-valvular atrial fibrillation. Europace. 2015; 17(10): 1467–1507.
- Providência R, Albenque JP, Combes S, et al. Safety and efficacy of dabigatran versus warfarin in patients undergoing catheter ablation of atrial fibrillation: a systematic review and meta-analysis. Heart. 2014; 100(4): 324–335.
- Rowley CP, Bernard ML, Brabham WW, et al. Safety of continuous anticoagulation with dabigatran during implantation of cardiac rhythm devices. Am J Cardiol. 2013; 111(8): 1165–1168.
- Calkins H, Kuck KH, Cappato R, et al. 2012 HRS/ EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design. EP Europace. 2012; 14: 528–606.
- Nagao T, Inden Y, Shimano M, et al. Feasibility and safety of uninterrupted dabigatran therapy in patients undergoing ablation for atrial fibrillation. Intern Med. 2015; 54(10): 1167–1173.
- Kutinsky IB, Jarandilla R, Jewett M, et al. Risk of hematoma complications after device implant in the clopidogrel era. Circ Arrhythm Electrophysiol. 2010; 3(4): 312–318.
- Badr S, Kitabata H, Torguson R, et al. Incidence and correlates in the development of iatrogenic femoral pseudoaneurysm after percutaneous coronary interventions. J Interv Cardiol. 2014; 27(2): 212–216.
- Dzijan-Horn M, Langwieser N, Groha P, et al. Safety and efficacy of a potential treatment algorithm by using manual compression repair and ultrasound-guided thrombin injection for the management of iatrogenic femoral artery pseudoaneurysm in a large patient cohort. Circ Cardiovasc Interv. 2014; 7(2): 207–215.
- Ansell J, Hirsh J, Hylek E, et al. American College of Chest Physicians. Pharmacology and management of the vitamin K antagonists: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest. 2008; 133(6 Suppl): 160S–198S.
- Douketis JD, Spyropoulos AC, Spencer FA. at al. Perioperative Management of Antithrombotic Therapy and Prevention of Thrombosis (9th ed.). American College of Physicians evidence-based clinical practice guidelines. Chest. 2012; 141(2 Suppl): 326S–350S.
