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Prevention of venous thrombosis after electrophysiology procedures: a survey of national practice

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Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusions

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.

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Acknowledgements

Drs. Essebag, Sapp, Joza, Andrade, Birnie, Healey, Leong-Sit, Philippon, Redfearn, and Sandhu are Network Investigators of the Cardiac Arrhythmia Network of Canada (CANet).

Funding

This work was supported by a Clinical Research Scholar Award to Vidal Essebag from Fonds de recherche du Quebec-Santé (FRQS).

Author information

Authors and Affiliations

  1. McGill University Health Centre, 1001 Decarie Blvd, Montreal, QC, H4A 3J1, Canada

    Barry Burstein, Rodrigo S. Barbosa, Michelle Samuel, Eli Kalfon, Jacqueline Joza, Martin Bernier & Vidal Essebag

  2. Hospital Albert Sabin, Rua Doutor Edgar Carlos Pereira, 600 - Santa Teresa, Juiz de Fora, MG, 36020-200, Brazil

    Rodrigo S. Barbosa

  3. Galilee Medical Center, POB 21, 2210001, Nahariya, Israel

    Eli Kalfon

  4. Institut universitaire de cardiologie et de pneumologie de Québec, 2725 Ch Ste-Foy, Québec, QC, G1V 4G5, Canada

    François Philippon

  5. University of Ottawa Heart Institute, 40 Ruskin St, Ottawa, ON, K1Y 4W7, Canada

    David Birnie

  6. St. Michael’s Hospital, 30 Bond St, Toronto, ON, M5B 1W8, Canada

    Iqwal Mangat

  7. Kingston Health Sciences Centre, 166 Brock Street, Kingston, ON, K7L 5G2, Canada

    Damian Redfearn

  8. University of Alberta Hospital, 8440 112 St NW, Edmonton, AB, T6G 2B7, Canada

    Roopinder Sandhu

  9. Montreal Heart Institute, 5000 Rue Bélanger, Montréal, QC, H1T 1C8, Canada

    Laurent Macle

  10. QEII Health Sciences Centre, 1799 Robie St, Halifax, NS, B3H 3G1, Canada

    John Sapp

  11. Southlake Regional Health Centre, 596 Davis Dr, Newmarket, ON, L3Y 2P9, Canada

    Atul Verma

  12. Hamilton Health Sciences Centre, 237 Barton St. East, Hamilton, ON, L8L 2X2, Canada

    Jeff S. Healey

  13. Hôpital Sacré-Coeur de Montréal, 5400 Boul Gouin O, Montréal, QC, H4J 1C5, Canada

    Giuliano Becker & Vidal Essebag

  14. University Health Network, University of Toronto, 200 Elizabeth St, Toronto, ON, M5G 2C4, Canada

    Vijay Chauhan

  15. Centre hospitalier de l’Université de Montréal (CHUM), 1051 Rue Sanguinet, Montreal, QC, H2X 3E4, Canada

    Benoit Coutu

  16. Centre hospitalier universitaire de Sherbrooke (CHUS), 580 Rue Bowen S, Sherbrooke, QC, J1G 2E8, Canada

    Jean-François Roux

  17. London Health Sciences Centre, 800 Commissioners Road East, London, ON, N6A 5W9, Canada

    Peter Leong-Sit

  18. Vancouver General Hospital, 899 W 12th Ave, Vancouver, BC, V5Z 1M9, Canada

    Jason G. Andrade

  19. Libin Cardiovascular Institute of Alberta, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada

    George D. Veenhuyzen

  20. McGill University Health Centre, 1650 Cedar Ave, E5-200, Montreal, QC, H3G 1A4, Canada

    Vidal Essebag

Authors
  1. Barry Burstein
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  2. Rodrigo S. Barbosa
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  3. Michelle Samuel
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  4. Eli Kalfon
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  5. François Philippon
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  6. David Birnie
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  7. Iqwal Mangat
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  8. Damian Redfearn
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  9. Roopinder Sandhu
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  10. Laurent Macle
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  11. John Sapp
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  12. Atul Verma
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  13. Jeff S. Healey
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  14. Giuliano Becker
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  15. Vijay Chauhan
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  16. Benoit Coutu
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  17. Jean-François Roux
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  18. Peter Leong-Sit
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  19. Jason G. Andrade
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  20. George D. Veenhuyzen
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  21. Jacqueline Joza
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  22. Martin Bernier
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  23. Vidal Essebag
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Corresponding author

Correspondence to Vidal Essebag.

Ethics declarations

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.

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Burstein, B., Barbosa, R.S., Samuel, M. et al. Prevention of venous thrombosis after electrophysiology procedures: a survey of national practice. J Interv Card Electrophysiol 53, 357–363 (2018). https://doi.org/10.1007/s10840-018-0461-9

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  • DOI: https://doi.org/10.1007/s10840-018-0461-9

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