Transvenous lead extraction during uninterrupted warfarin therapy: Feasibility and outcomes.

BACKGROUND: Uninterrupted anticoagulation is important for patients at high risk for thromboembolism. Bridging with heparin/enoxaparin increases the risk of hematoma and infection. There are no published data on the feasibility of transvenous lead extraction (TLE) during uninterrupted anticoagulation.

OBJECTIVE: The purpose of this study was to examine the feasibility and safety of TLE during uninterrupted warfarin therapy with therapeutic international normalized ratio (INR).

METHODS: We performed a retrospective study of patients undergoing TLE while receiving uninterrupted warfarin therapy with INR ≥2.0 at a high-volume center.

RESULTS: Between March 2011 and December 2016, 1212 patients underwent TLE. Of these patients, 62 underwent TLE during uninterrupted warfarin therapy with therapeutic INR (mean 2.5 ± 0.5; range 2.0-4.5). The cohort was 85% male, mean age 65 years, CHA2 DS2 -VASc score 3.4 ± 1.6, and left ventricular ejection fraction 41% ± 16%. A total of 114 of 116 leads were completely removed. These include 45 (38.4%) defibrillator leads of average age 7.8 ± 3.7 years, 65 (55.6%) pace-sense leads of average age 10.5 ± 6.6 years, and 6 (5.2%) coronary sinus lead of average age 5.5 ± 3.4 years. There was a 98.4% procedural and clinical success rate. Two patients had procedure-related complications: 1 small pericardial effusion that resolved spontaneously, and 1 femoral vein tear due to extraction of a large mass of a disrupted implantable cardioverter-defibrillator lead requiring vascular repair.

CONCLUSION: TLE during uninterrupted warfarin therapy with therapeutic INR may be considered in patients at high risk for thromboembolism if performed by experienced operators at high-volume centers.