Background: The safety of continuous vitamin-k-antagonists (VKAs) – in comparison with bridging therapy in patients undergoing cardiac implantable electronic devices (CIED) implantation – has been shown previously. So far, data on continuous therapy with apixaban, dabigatran and rivaroxaban appear to be missing.

Methods and Results: The aim of this study was to evaluate the safety of continuous NOAC intake compared to VKAs in patients undergoing cardiac rhythm device implantation or a generator change.

529 patients were included. Each patient was treated with one of four different anticoagulation regimes: 223 (42.2%) with VKAs; 148 (27.9%) with apixaban, 93 (17.6%) with rivaroxaban and 65 (12.3%) with dabigatran. The four groups were comparable with regard to age (VKAs 75 years [69;79]; apixaban 76 years [70;80]; rivaroxaban 67 years [74;78] and dabigatran 72 years [64;79]; p=0.011), CHA₂DS₂VASc Score (VKAs 4 [3;5], apixaban 4 [3;5], rivaroxaban 4 [3;5], and dabigatran 4 [3;5]; p=0.075), and HAS-BLED score (VKAs 2 [2;3], apixaban 2 [2;3], rivaroxaban 2 [2;3] and dabigatran 2 [2;3]; p=0.071).

20 (0.4%) patients demonstrated major bleeding events. No ischemic complication was documented in this patient cohort. With regard to major bleeding events no significant differences were observed between the different anticoagulation regimes.

Conclusion: This is the largest study evaluating the safety of apixaban, dabigatran and rivaroxaban compared to phenprocoumon in patients undergoing CIED. Continuous medication with apixaban, rivaroxaban or dabigatran – in comparison with VKAs – appears to yield a comparable risk of bleeding and ischemic complications in patients undergoing CIED implantation or generator change.