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The use of new oral anticoagulants (NOACs) in numerous scenarios may be very interesting although their use always requires thorough evaluation regarding risks and benefits based on an in-depth understanding of each patient’s comorbidities. Their perioperative use also requires further study [1–5]. We would like to focus the attention on a possible interesting use of NOACs. Central venous occlusions in pacing patients are often asymptomatic [6, 7] due to the development of an adequate venous collateral circulation, but they can cause more difficulties in patients needing a device revision/upgrade/extraction requiring advanced tools and more time [6, 8]. So far several pacing venous occlusions have been described, including superior vena cava (SVC) occlusion [9–11], subclavian vein occlusion [12, 13], axillary vein occlusion [14], inferior vena cava (IVC) occlusion [15], subtotal innominate vein occlusion [16], and internal jugular vein occlusion [17]. Moreover permanent pacemaker-related upper extremity deep vein thrombosis has been found [18] with risk factors such as diabetes, most frequently, followed by smoking, hypertension, obesity with a body mass index ≥30, history of acute myocardial infarction, chronic obstructive pulmonary disease and history of congestive cardiac failure (15 %) and responding to anticoagulation therapy while antiplatelets were not found protective [18]. Also, atrial fibrillation, foreign body-type reaction, and hypercoagulability have been suggested as possible mechanisms of pacing venous thrombosis [19]. Notably, implantable cardioverter defibrillators leads, after a long dwell-time, have been found affected by fibrous adherences uniformly distributed along the lead course and careful lead selection is recommended at the time of implantation to prevent adherences [20]. We usually search to remove the preexisting electrodes with a percutaneous approach, but if the adhesions between the leads and the venous wall cannot be gone over, in our opinion the surgical strategy is often mandatory [21–23]. Nowadays prevention of pacing venous occlusions represents an increasingly serious challenge as well its optimal management. Furthermore, perioperative lead extraction management varies between extraction centers, and no clinical guidelines [24] have focused on the need for anticoagulation. Nevertheless, routine periand postoperative anticoagulation has been advocated as a means to prevent vein occlusions including pulmonary embolism [25, 26]. We think that NOACs may find a possible application in this emerging clinical scenario. Additional researches are needed and the journey of NOACs could be longer than expected.

Venous Occlusion after Transvenous Pacemaker Implantation—Is There a Role for New Oral Anticoagulants?