![]() ![]() Adverse events within 30 days of device implantation were also recorded including death, cause‐specific hospitalization (cardiovascular, bleeding, noncardiovascular, nonbleeding), myocardial infarction, stroke, or systemic embolism. ![]() Use of bridging anticoagulation was reported and categorized as unfractionated heparin, low‐molecular‐weight heparin, fondaparinux, or other. In patients who underwent cardiac device implantation, providers were queried regarding the type of device implanted (permanent pacemaker, implantable cardioverter‐defibrillator, or cardiac resynchronization therapy defibrillator), periprocedural international normalized ratio, and anticoagulation interruption. The specific anticoagulant utilized, monitoring data, bridging data, and outcomes were reported. Investigators reported any new medical or surgical therapies at each follow‐up. Data were submitted via a Web‐based form collected in 6‐month intervals after initial enrollment. The electronic medical record at each participating institution served as the primary data source. Patients with a life expectancy less than 6 months and patients participating in a randomized trial of stroke prevention therapy were excluded. Patients greater than 18 years of age with electrocardiographic evidence of atrial fibrillation who was not secondary to a reversible cause (eg, postoperative AF) were eligible for inclusion. 6 Primary care providers, cardiologist, and electrophysiologists enrolled patients in the clinic setting. The rationale and design of the registry has been previously described. ORBIT‐AF is a national, multicenter, prospective registry of ambulatory AF patients. We used patient data from the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT‐AF). The objective of this study was to describe patterns of anticoagulation management during CIED implantation and subsequent outcomes in AF patients in US clinical practice. Despite the growing popularity of NOACs, clinicians have limited data to inform their use in patients undergoing CIED implantation. However, the development and introduction of the non–vitamin K antagonist oral anticoagulants (NOACs) into clinical practice has challenged this standard, as many CIED patients are now being treated with NOACs and not warfarin. ![]() 3, 4, 5 Accordingly, uninterrupted warfarin has been considered the standard of care in patients with AF and moderate to high risk for stroke undergoing CIED implantation. Interruption of warfarin with heparin or low‐molecular‐weight heparin bridging prior to CIED implantation has been shown to lead to significantly increased bleeding and hematoma formation. Management of OAC in patients with AF has evolved over the past decade following the results of several important clinical trials. Perioperative management of OAC in AF patients is challenging and involves several clinical decisions, including whether or not to interrupt therapy. 1, 2 Atrial fibrillation (AF) is the most common indication for OAC in patients undergoing CIED implantation. Approximately 1 in 5 patients undergoing CIED implantation are chronically treated with oral anticoagulation (OAC) prior to surgery. Cardiac implantable electronic devices (CIEDs) prolong survival and may improve quality of life. ![]()
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