Background: Transvenous lead extraction is a potentially challenging aspect of comprehensive cardiac implantable device management due to adherence of pacing and defibrillation leads to the vessel wall with fibrous tissue. Prior studies have outlined a pathophysiologic basis for the progression of chronic clots to these fibrous adhesions. However, it is unknown if anticoagulation (AC) therapy during the life of an implanted lead makes device extraction easier.
Objective: To assess the association between AC use and \"difficulty\" of lead removal using laser time as a novel surrogate for ease of extraction.
Methods: Laser time data were available for 158 consecutive patients who underwent lead extractions at our center between 7/2015 to 11/2019 and were included in the study. Retrospective chart review was done for data retrieval and analysis was done using Stata statistical software.
Results: Mean age was 69 years. 72 (46%) were males. Mean LVEF was 40 ± 12. Mean body mass index was 30.1 kg/m2. 90 (57%) and 46 (29%) were taking aspirin and clopidogrel respectively while their leads were implanted. Antiplatelet use had no association with laser time. 47 patients (30%), 8 patients (5%), 4 patients (2.5%) and 4 patients were taking warfarin, rivaroxaban, dabigatran and apixaban respectively totaling 63 patients (39%) who were on AC while their leads were implanted. The median laser time for the cohort was 52 secs. Patients on AC had a shorter laser time (median laser time in AC patients: 50.4 secs, median laser time in non-AC patients: 56.0 secs, P = 0.061]. In a Logistic regression analysis, adjusted for gender, BMI, diabetes, duration of leads and adjusted for inverse probability weights (a type of propensity matching for comorbid variables), those who were on AC had a trend towards lower odds of having laser times lesser than the median cohort laser time when compared to those who were not on AC (OR: 0.77, 95% CI: 0.42 - 1.01, P = 0.057].
Conclusion: AC does not have a statistically significant impact on laser time during transvenous lead extraction. There is, however, a trend towards lower laser times in those that were exposed to AC while leads were implanted. Larger sample studies are needed to further explore this topic.