Evidence map›Paper›PMID 39546144›Full record

SynthesisJournal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing2025

Perioperative direct oral anticoagulant management during cardiac implantable electronic device surgery: an updated systematic review and meta-analysis.

Chidubem Ezenna, Vinicius Pereira, Mohammed Abozenah, Ancy Jenil Franco, Oghenetejiri Gbegbaje, Ayesha Zaidi, Mrinal Murali Krishna, Meghna Joseph, Prasana Ramesh, Fadi Chalhoub

Abstract readSystematic ReviewMeta-Analysis
PubMed Publisher
In one paragraph

Synthesis in Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Chidubem EzennaDepartment of Medicine, University of Massachusetts Chan Medical School - Baystate Medical Center, 759 Chestnut Street, Springfield, MA, 01104, USA. cezenna349@gmail.com.ORCID http://orcid.org/0009-0001-3988-6211
Vinicius PereiraFaculty of Medicine, Universidad Austral, Pilar, Argentina.
Mohammed AbozenahDepartment of Cardiovascular Medicine, University of Massachusetts Chan Medical School - Baystate Medical Center, Springfield, MA, USA.
Ancy Jenil FrancoDepartment of Medicine, Sri Muthukumaran Medical College Hospital and Research Institute, Chennai, India.
Oghenetejiri GbegbajeEnglewood Hospital and Medical Center, Englewood, NJ, USA.
Ayesha ZaidiDepartment of Medicine, University of Massachusetts Chan Medical School - Baystate Medical Center, 759 Chestnut Street, Springfield, MA, 01104, USA.
Mrinal Murali KrishnaDepartment of Medicine, Medical College Thiruvananthapuram, Thiruvananthapuram, India.
Meghna JosephDepartment of Medicine, Medical College Thiruvananthapuram, Thiruvananthapuram, India.
Prasana RameshDepartment of Medicine, University of Massachusetts Chan Medical School - Baystate Medical Center, 759 Chestnut Street, Springfield, MA, 01104, USA.
Fadi ChalhoubDepartment of Cardiovascular Medicine, University of Massachusetts Chan Medical School - Baystate Medical Center, Springfield, MA, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundPatients undergoing cardiovascular implantable electronic device (CIED) implantation are often on direct oral anticoagulation (DOAC). However, the evidence on whether to continue or temporarily discontinue DOAC therapy during the perioperative period in these patients is unclear.

methodsWe conducted a comprehensive literature review using PubMed, Embase, and Cochrane databases through July 2024. We included studies comparing uninterrupted versus interrupted perioperative DOAC therapy in patients undergoing CIED procedure- primary implants, pulse generator replacement, and device upgrades. Primary outcomes were clinically significant device-pocket hematoma and thromboembolic events. Secondary outcomes included any device-pocket hematoma, all-cause mortality, major bleeding, and any bleeding.

resultsA total of 1,607 patients from 8 studies were included. The mean age was 73.2 years, with atrial fibrillation as the indication for DOAC therapy in most patients. The mean CHA2DS2-VASc was 3.4. Among the included studies, 2 were randomized control trials (RCTs), while the others were observational cohort studies, including one that was propensity score matched. Our meta-analysis found both strategies to be similar in terms of clinically significant pocket hematoma (RR 1.70; 95%CI 0.84-3.45; p = 0.14; I

conclusionThis meta-analysis shows that uninterrupted DOAC therapy is comparable to interrupted therapy for CIED procedures, with a potential increase in major bleeding risk but low overall complication rates. Further research is needed to confirm the best approach of periprocedural anticoagulation in these patients.

Indexed as

AnticoagulantsDefibrillators, ImplantablePacemaker, ArtificialPerioperative CareThromboembolismAdministration, OralAtrial FibrillationHematomaHumansAnticoagulantsBleedingDefibrillatorDirect oral anticoagulantsDOACHematomaPacemaker

Identifiers

PMID39546144

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.