Abstract 13128: Antithrombotic Therapy and Outcomes after ICD Implantation: An Analysis from the Linked NCDR-CMS Claims Database
Background: Atrial fibrillation (AF) is a common arrhythmia in patients who receive implantable cardioverter defibrillators (ICDs). Post-procedural management of anticoagulation is challenging, particularly when it involves patients with coronary artery disease (CAD) who require antiplatelet agents as well. Accordingly, we examined variation in post-procedural management of anticoagulation in patients undergoing first time ICD implant with AF and CAD to determine early risks of bleeding and thromboembolic events (TEs) following discharge.
Methods: Admissions for 105,569 patients without prior ICD in the National Cardiovascular Data Registry (NCDR) ICD Registry from January 2006 to December 2009 were linked with Centers for Medicare & Medicaid Services data. Those without history of AF, CAD and without a match in the linked data were excluded, leaving 25,180 patients. Patients were categorized into 5 different groups according to post-discharge antithrombotic agents (any one antiplatelet agent [A], dual antiplatelet therapy [DA], warfarin [W], [W] + [A], [W] +[DA]). We assessed 30 day bleeding and TEs in these groups using Cox regression models that adjusted for patient and procedural characteristics.
Results: Patients who received DA with or without W had more cerebrovascular disease, diabetes, and hypertension. Overall, 575 (2.28%) and 356 (1.41%) bleeding and TEs were observed. The combinations of DA, W + A, and W + DA were independently associated with a higher of risk of bleeding. There was no independent relationship between any post-procedural medication groups and TEs (Table 1).
Conclusion: Patients discharged on DA, W + A or DA + W have a higher risk of short-term bleeding but comparable risk of TEs. These data underscore challenges associated with antithrombotic therapy following ICD implantation and suggest the need for novel strategies to reduce the risk of complications in this population.
- © 2013 by American Heart Association, Inc.