Previous studies showed that continuous anticoagulation or single antiplatelet
therapy during implantations of cardiac implantable electronic devices (CIED) was relatively safe. However, the safety of continuous multi antithrombotic
therapy (AT) in patients undergoing CIED interventions has not been clearly defined. We sought to evaluate the safety of this
therapy during CIED implantations. A total of 300 consecutive patients (mean 69 years old, 171 males) with CIED implantations were enrolled in this study. The patients were divided into 6 groups [No-AT, oral
anticoagulant therapy (OAT), single antiplatelet
therapy (SAPT), OAT and SAPT, dual antiplatelet
therapy (
DAPT), triple AT (TAT)], and the perioperative complications were evaluated. Clinically significant pocket
hematomas (PH) were defined as PH needing surgical intervention, prolonged hospitalizations, interruption of AT, or blood product transfusions. There were 129, 89, 49, 20, 10, and 3 patients in No-AT, OAT, SAPT, OAT + SAPT,
DAPT, and TAT groups, respectively. The occurrence of clinically significant PH and
thromboembolism did not differ among 6 groups (p = 0.145 and p = 0.795, respectively). However, high HAS-BLED score and
valvular heart disease (VHD) were associated with clinically significant PH (p = 0.014 and p = 0.015, respectively). Continuous multi AT may be tolerated, but patients with high HAS-BLED score or VHD would require a careful attention during CIED implantations.