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Monitoring through ICDs, pacemakers decreases anticoagulation administration
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Direct-acting oral anticoagulation through pacemakers or implantable cardioverter defibrillators was feasible and decreased the utilization of anticoagulation in patients with rare atrial fibrillation episodes who had low to moderate stroke risk, according to a study published in HeartRhythm.
“Use of [direct-acting oral anticoagulation] instead of warfarin has increased dramatically over the last few years, and although these drugs have many beneficial properties (eg, fewer dietary/drug interactions and no need for long-term drug-level monitoring), they are significantly more expensive than warfarin,” Jonathan W. Waks, MD, instructor in medicine at Beth Israel Deaconess Medical Center, and colleagues wrote. “Thus, [tailored anticoagulation] also has the potential to reduce costs associated with AF in appropriate patients.”
Researchers analyzed data from 48 patients (mean age, 71 years; 65% men) with pacemakers or ICDs by St. Jude Medical with a functioning atrial lead and a generator to allow remote monitoring. Patients also had at least one AF episode, a CHADS2 score less than 3, low AF burden and no continuous AF episodes lasting longer than 6 minutes. All patients took an approved direct oral anticoagulant for at least 30 consecutive days.
Remote transmissions from the pacemaker or ICD (Merlin.net, St. Jude Medical) were used to determine whether tailored anticoagulation therapy should be initiated or discontinued.
Information obtained during enrollment included medical history, patient characteristics, NYHA functional class, CHADS2 score and quality of life assessment. Follow-up visits were conducted at 6 and 12 months, when NYHA functional class, quality of life and CHADS2 score were reassessed.
The primary outcome was the number of days on anticoagulation. Secondary outcomes of interest included quality of life and adverse events.
Of the patients in the study, 87.5% had a CHADS2 score of 1 or 2, and 79.2% had paroxysmal AF.
During 14,826 days of monitoring, patients were treated with direct oral anticoagulation for 3,763 days, which represented a 74.6% reduction in the amount of time patients were treated compared with those who were treated with continuous anticoagulation.
Three hemorrhagic events occurred during follow-up, including two minor gastrointestinal bleeding events in patients on anticoagulation and one fatal intracranial hemorrhage in a patient not on anticoagulation. No strokes or transient ischemic attacks occurred, the researchers wrote.
“Future studies evaluating [tailored anticoagulation] are warranted to determine the overall safety of this novel approach to anticoagulation for AF and before this approach can be used clinically,” Waks and colleagues wrote. “If future studies confirm the safety of [tailored anticoagulation], patients may be allowed to personalize their anticoagulation care based on real-time continuous arrhythmia monitoring, just as diabetics adjust their daily insulin dosages based on blood sugar measurements.” – by Darlene Dobkowski
Disclosures: The study was funded by St. Jude Medical. Waks reports he received honoraria from Boston Scientific. Please see the study for all other authors’ relevant financial disclosures.
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