216-43: Major bleeding complications during cardiac electronic device implantation in patients receiving antithrombotic therapy: do local tranexamic acid have any preventive role?

Abstract

Background: The perioperative use of antithrombotic therapy is associated with increased bleeding risk after cardiac implantable electronic device (CIED) implantation. Topical application of tranexamic acid (TXA) is effective in reducing bleeding complications after various surgical operations. However, there is no information regarding local TXA application during CIED procedures. The purpose of our study was to evaluate major bleeding complication rates during CIED implantation with and without topical TXA use in patients receiving antithrombotic treatment. Methods: Consecutive patients undergoing CIED implantation while receiving warfarin or dual antiplatelet (DAPT) or warfarin plus DAPT treatment were included in the study. Study population was divided in two groups according to presence or absence of topical TXA use during CIED implantation. Major bleeding complications (MBC) defined as any bleeding leading to transfusion, surgical intervention for pocket evacuation or revision, pericardial effusion, hemothorax, or life-threatening bleed. Thromboembolic events were defined as transient ischemic attack, stroke, myocardial infarction, deep vein thrombosis, and pulmonary embolism within 90 days of procedure. Results: A total of 135 consecutive patients were identified and included in the analysis. The mean age was 60 years old. Topical TXA application during implantation was reported in 52 patients (TXA group). The remaining 83 patients were assigned to the control group. The major bleeding complication rate was lower in TXA group compared to control group (5.8% vs 20.5%, P = 0.024). Univariate logistic regression analysis identified history of recent stent implantation, perioperative warfarin use, perioperative warfarin plus DAPT use and topical TXA application during CIED procedure as predicting factors of MBC. Multivariate analysis of factors with P<0.1 in univariate analysis showed that perioperative warfarin plus DAPT use (OR = 8.144, 95% CI: 2.589-25.618, P < 0.001) and topical TXA application during CIED procedure (OR = 0.170, 95% CI: 0.042-0.690, P = 0.013) were independent predictors of MBC. No thromboembolic complications was recorded in the study group. Conclusions: The present study demonstrated for the first time that the topical TXA application during CIED implantation is associated with reduced MBC in patients with high bleeding risk.