Pre-CIED Implant Antithrombotic Therapy and the Risk of Lead-Related Venous Obstruction and Bleeding

Document Type

Conference Proceeding

Publication Date

4-2026

Publication Title

Heart Rhythm

Abstract

Background: Lead-related venous obstruction (LRVO) and bleeding after cardiac implantable electronic device (CIED) placement are well-known complications, yet guidance on periprocedural antithrombotic management remains limited. Objective: We assessed the effects of preprocedural antithrombotics on post-CIED LVRO and bleeding. Methods: We used TriNetX to identify adults (≥18 years) receiving first-time CIED implantation and excluded those with prior upper-extremity thromboembolism or major bleeding. Patients were categorized by antithrombotic use within 1 week before CIED implantation: naïve (never had antithrombotic therapy before CIED), antiplatelet therapy (APT) alone, anticoagulation (AC) alone, and combined APT+AC. Propensity score matching balanced baseline characteristics. Outcomes were 5-year major bleeding (gastrointestinal/ intracranial bleeding), pocket hematoma, LRVO, CIED removal, and all-cause hospitalization. Results: Among 65,713 first-time CIED recipients, 40.1% were antithrombotic-naïve, and pre-CIED agents included AC alone (7.8%), APT alone (39.7%), or APT+AC (12.4%). Outcomes were compared to the naïve group after propensity score matching. Compared with the naïve group, all antithrombotic strategies had similar risks of LRVO and CIED removal. AC alone was not associated with higher major bleeding or hematoma. APT alone was associated with a modest increase in major bleeding (HR 1.09, P50.04) without higher hematoma risk, whereas APT+AC was associated with higher risks of both major bleeding (HR 1.46, P,0.01) and hematoma (HR 1.64, P,0.01). All antithrombotic groups had higher all-cause hospitalization rates than the naïve cohort. Conclusion: Antithrombotic therapy before CIED implantation did not lower LRVO risk. These findings support LRVO as mainly prosthetic-related, with limited protection from pre-procedural antithrombotics. However, bleeding risk varied by regimen: AC alone might be safe, while APT, especially APT+AC, might be associated with higher bleeding risks.

Volume

23

Issue

4 Suppl

First Page

S302

Comments

Heart Rhythm Society Annual Meeting, April 23-26, 2026, Chicago, IL

Last Page

S302

DOI

10.1016/j.hrthm.2026.03.1793

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