From the Research
Patients do not generally require anticoagulation or antiplatelet therapy after Micra leadless pacemaker placement, unless it is indicated for their underlying medical conditions. The decision to use anticoagulation or antiplatelet therapy should be based on the patient's individual risk factors, such as atrial fibrillation or coronary artery disease, rather than the device itself 1.
Key Considerations
- The Micra pacemaker's small size and direct implantation into the right ventricle reduce the risk of pocket hematoma and lead-related complications that might otherwise warrant anticoagulation management considerations.
- The device becomes endothelialized over time, which further reduces any theoretical risk of device-related thrombosis.
- If a patient was on anticoagulation before the procedure, it can typically be restarted 24-48 hours after implantation, assuming adequate hemostasis at the femoral access site.
- Patients should follow their cardiologist's specific instructions, as individual factors such as bleeding risk, comorbidities, and the indication for the original anticoagulation therapy will influence post-procedure medication management.
Evidence Summary
The study by 1 found that bleeding and thromboembolic complications after Micra leadless pacemaker placement are infrequent, and the use of anticoagulant therapy does not increase the complications associated with the procedure. Another study by 2 also found that the rate of peri-procedural groin, hemorrhagic, and thromboembolic complications was extremely low, with minimal differences between oral anticoagulants.
Clinical Implications
In clinical practice, the management of anticoagulation after Micra leadless pacemaker placement should be individualized, taking into account the patient's underlying medical conditions and risk factors. The decision to use anticoagulation or antiplatelet therapy should be based on the patient's individual needs, rather than a blanket approach for all patients with the device.