Prevention of venous thrombosis after electrophysiology procedures: a survey of national practice
Femoral venous access is required for most electrophysiology procedures. Limited data are available regarding post-procedure venous thromboembolism (VTE), specifically deep vein thrombosis (DVT) and pulmonary embolism (PE). Potential preventative strategies are unclear. We aimed to survey Canadian centers regarding incidence of VTE and strategies for prevention of VTE after procedures that do not require post-procedure anticoagulation.
An online survey was distributed to electrophysiologists representing major Canadian EP centers. Participants responded regarding procedural volume, incidence of VTE post-procedure, and their practice regarding pharmacological and non-pharmacological peri-procedural VTE prophylaxis.
The survey included 17 centers that performed a total of 6062 procedures in 2016. Ten patients (0.16%) had VTE (including 9 DVTs and 6 PEs) after diagnostic electrophysiology studies and right-sided ablation procedures excluding atrial flutter. Five centers (41.6%) administered systemic intravenous heparin during both diagnostic electrophysiology studies and right-sided ablation procedures. For patients taking oral anticoagulants, 10 centers (58.8%) suspend therapy prior to the procedure. Two centers (11.8%) routinely prescribed post-procedure pharmacologic prophylaxis for VTE. Four centers (23.5%) used compression dressings post-procedure and all prescribed bed rest for a maximum of 6 h. Of the variables collected in the survey, none were found to be predictive of VTE.
VTE is not a common complication of EP procedures. There is significant variability in the strategies used to prevent VTE events. Future research is required to evaluate strategies to reduce the risk of VTE that may be incorporated into EP practice guidelines.
KeywordsElectrophysiology study Ablation Deep vein thrombosis Prevention Prophylaxis
Drs. Essebag, Sapp, Joza, Andrade, Birnie, Healey, Leong-Sit, Philippon, Redfearn, and Sandhu are Network Investigators of the Cardiac Arrhythmia Network of Canada (CANet).
This work was supported by a Clinical Research Scholar Award to Vidal Essebag from Fonds de recherche du Quebec-Santé (FRQS).
Compliance with ethical standards
The study was approved by the McGill University Health Centre (MUHC) Research Ethics Board (REB).
Conflict of interest
The authors declare that they have no conflict of interest.
- 1.Sticherling C, Marin F, Birnie D, Boriani G, Calkins H, Dan GA, et al. Antithrombotic management in patients undergoing electrophysiological procedures: a European Heart Rhythm Association (EHRA) position document endorsed by the ESC Working Group Thrombosis, Heart Rhythm Society (HRS), and Asia Pacific Heart Rhythm Society (APHRS). Europace. 2015;17(8):1197–214. https://doi.org/10.1093/europace/euv190.CrossRefPubMedGoogle Scholar
- 2.Samuel M, Almohammadi M, Tsadok MA, Joza J, Jackevicius CA, Koh M, et al. Population-based evaluation of major adverse events after catheter ablation for atrial fibrillation. JACC: Clin Electrophysiol. 2017;3(12):1425–33.Google Scholar
- 6.Chen SA, Chiang CE, Tai CT, Cheng CC, Chiou CW, Lee SH, et al. Complications of diagnostic electrophysiologic studies and radiofrequency catheter ablation in patients with tachyarrhythmias: an eight-year survey of 3,966 consecutive procedures in a tertiary referral center. Am J Cardiol. 1996;77(1):41–6. https://doi.org/10.1016/S0002-9149%2897%2989132-1.CrossRefPubMedGoogle Scholar
- 9.Kumar S, Walters TE, Halloran K, Morton JB, Hepworth G, Wong CX, et al. Ten-year trends in the use of catheter ablation for treatment of atrial fibrillation vs. the use of coronary intervention for the treatment of ischaemic heart disease in Australia. Europace. 2013;15(12):1702–9. https://doi.org/10.1093/europace/eut162.CrossRefPubMedGoogle Scholar
- 10.Calkins H, Kuck KH, Cappato R, Brugada J, Camm AJ, Chen SA, et al. 2012 HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design. Europace. 2012;14(4):528–606. https://doi.org/10.1093/europace/eus027.CrossRefPubMedGoogle Scholar
- 14.January CT, Wann LS, Alpert JS, Calkins H, Cigarroa JE, Cleveland JC Jr, et al. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol. 2014;64(21):e1–76. https://doi.org/10.1016/j.jacc.2014.03.022.CrossRefPubMedGoogle Scholar
- 16.Kahn SR, Lim W, Dunn AS, Cushman M, Dentali F, Akl EA, et al. Prevention of VTE in nonsurgical patients: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2012;141(2 Suppl):e195S–226S. https://doi.org/10.1378/chest.11-2296.CrossRefPubMedPubMedCentralGoogle Scholar
- 17.Garcia DA, Baglin TP, Weitz JI, Samama MM. Parenteral anticoagulants: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2012;141(2 Suppl):e24S–43S. https://doi.org/10.1378/chest.11-2291.CrossRefPubMedPubMedCentralGoogle Scholar
- 18.Guyatt GH, Akl EA, Crowther M, Gutterman DD, Schuunemann HJ, American College of Chest Physicians Antithrombotic T, et al. Executive summary: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2012;141(2 Suppl):7S–47S. https://doi.org/10.1378/chest.1412S3.CrossRefPubMedPubMedCentralGoogle Scholar