Anticoagulation management in the perioperative phase of implantable cardioverter defbrillator implantation
Hisashi Yokoshiki, Hirofumi Mitsuyama, Masaya Watanabe, Kazuya Mizukami, Yoshiro Matsui, Hiroyuki Tsutsui
Background: According to the current guidelines, substitution of warfarin with heparin is recommended as perioperative management in patients with high risk of thromboembolism. Optimal management of oral anticoagulation in patients undergoing implantable cardioverter defibrillator (ICD) implantation, however, remains controversial. Methods and Results: Bleeding complications among 273 consecutive patients undergoing initial ICD implantation were retrospectively analyzed. Patients were grouped according to medication at the time of device implantation: neither antiplatelet nor anticoagulation (N group, n=121); antiplatelet only (AP group, n=59); warfarin (W group, n=59); and heparin bridging (H group, n=34). The rate of the major bleeding complications, defined as hematoma requiring reoperation, cardiac tamponade, and pericardial effusion requiring additional hospital stay, was 1.7% in the N group, 0% in the AP group, 5.1% in the W group, and 17.6% in the H group (P<0.001, N group vs. H group). After multivariate adjustment, heparin bridging was a significant predictor of major bleeding complications (odds ratio, 7.44; 95% confidence interval: 2.06-26.89; P=0.0022). The international normalized ratio of 3 patients in the W group with major bleeding complications was 1.98±0.10, and was significantly higher than in patients without them (1.31±0.05, n=26, P<0.001). Conclusions: Heparin bridging increased the risk of bleeding complications at the time of ICD implantation.
Circulation Journal
https://doi.org/10.1253/circj.CJ-12-1507
Implantable Defibrillators
Thromboembolism
Yokoshiki, H., Mitsuyama, H., Watanabe, M., Mizukami, K., Matsui, Y., & Tsutsui, H. (2013). Anticoagulation management in the perioperative phase of implantable cardioverter defbrillator implantation. Circulation Journal, 77(8), 2003-2008. https://doi.org/10.1253/circj.CJ-12-1507
Anticoagulation management in the perioperative phase of implantable cardioverter defbrillator implantation. / Yokoshiki, Hisashi; Mitsuyama, Hirofumi; Watanabe, Masaya; Mizukami, Kazuya; Matsui, Yoshiro; Tsutsui, Hiroyuki.
In: Circulation Journal, Vol. 77, No. 8, 02.08.2013, p. 2003-2008.
Yokoshiki, H, Mitsuyama, H, Watanabe, M, Mizukami, K, Matsui, Y & Tsutsui, H 2013, 'Anticoagulation management in the perioperative phase of implantable cardioverter defbrillator implantation', Circulation Journal, vol. 77, no. 8, pp. 2003-2008. https://doi.org/10.1253/circj.CJ-12-1507
Yokoshiki H, Mitsuyama H, Watanabe M, Mizukami K, Matsui Y, Tsutsui H. Anticoagulation management in the perioperative phase of implantable cardioverter defbrillator implantation. Circulation Journal. 2013 Aug 2;77(8):2003-2008. https://doi.org/10.1253/circj.CJ-12-1507
Yokoshiki, Hisashi ; Mitsuyama, Hirofumi ; Watanabe, Masaya ; Mizukami, Kazuya ; Matsui, Yoshiro ; Tsutsui, Hiroyuki. / Anticoagulation management in the perioperative phase of implantable cardioverter defbrillator implantation. In: Circulation Journal. 2013 ; Vol. 77, No. 8. pp. 2003-2008.
@article{0981fe3b747748fab462b5852002e354,
title = "Anticoagulation management in the perioperative phase of implantable cardioverter defbrillator implantation",
abstract = "Background: According to the current guidelines, substitution of warfarin with heparin is recommended as perioperative management in patients with high risk of thromboembolism. Optimal management of oral anticoagulation in patients undergoing implantable cardioverter defibrillator (ICD) implantation, however, remains controversial. Methods and Results: Bleeding complications among 273 consecutive patients undergoing initial ICD implantation were retrospectively analyzed. Patients were grouped according to medication at the time of device implantation: neither antiplatelet nor anticoagulation (N group, n=121); antiplatelet only (AP group, n=59); warfarin (W group, n=59); and heparin bridging (H group, n=34). The rate of the major bleeding complications, defined as hematoma requiring reoperation, cardiac tamponade, and pericardial effusion requiring additional hospital stay, was 1.7{\%} in the N group, 0{\%} in the AP group, 5.1{\%} in the W group, and 17.6{\%} in the H group (P<0.001, N group vs. H group). After multivariate adjustment, heparin bridging was a significant predictor of major bleeding complications (odds ratio, 7.44; 95{\%} confidence interval: 2.06-26.89; P=0.0022). The international normalized ratio of 3 patients in the W group with major bleeding complications was 1.98±0.10, and was significantly higher than in patients without them (1.31±0.05, n=26, P<0.001). Conclusions: Heparin bridging increased the risk of bleeding complications at the time of ICD implantation.",
author = "Hisashi Yokoshiki and Hirofumi Mitsuyama and Masaya Watanabe and Kazuya Mizukami and Yoshiro Matsui and Hiroyuki Tsutsui",
doi = "10.1253/circj.CJ-12-1507",
journal = "Circulation Journal",
publisher = "Japanese Circulation Society",
T1 - Anticoagulation management in the perioperative phase of implantable cardioverter defbrillator implantation
AU - Yokoshiki, Hisashi
AU - Mitsuyama, Hirofumi
AU - Watanabe, Masaya
AU - Mizukami, Kazuya
AU - Matsui, Yoshiro
AU - Tsutsui, Hiroyuki
N2 - Background: According to the current guidelines, substitution of warfarin with heparin is recommended as perioperative management in patients with high risk of thromboembolism. Optimal management of oral anticoagulation in patients undergoing implantable cardioverter defibrillator (ICD) implantation, however, remains controversial. Methods and Results: Bleeding complications among 273 consecutive patients undergoing initial ICD implantation were retrospectively analyzed. Patients were grouped according to medication at the time of device implantation: neither antiplatelet nor anticoagulation (N group, n=121); antiplatelet only (AP group, n=59); warfarin (W group, n=59); and heparin bridging (H group, n=34). The rate of the major bleeding complications, defined as hematoma requiring reoperation, cardiac tamponade, and pericardial effusion requiring additional hospital stay, was 1.7% in the N group, 0% in the AP group, 5.1% in the W group, and 17.6% in the H group (P<0.001, N group vs. H group). After multivariate adjustment, heparin bridging was a significant predictor of major bleeding complications (odds ratio, 7.44; 95% confidence interval: 2.06-26.89; P=0.0022). The international normalized ratio of 3 patients in the W group with major bleeding complications was 1.98±0.10, and was significantly higher than in patients without them (1.31±0.05, n=26, P<0.001). Conclusions: Heparin bridging increased the risk of bleeding complications at the time of ICD implantation.
AB - Background: According to the current guidelines, substitution of warfarin with heparin is recommended as perioperative management in patients with high risk of thromboembolism. Optimal management of oral anticoagulation in patients undergoing implantable cardioverter defibrillator (ICD) implantation, however, remains controversial. Methods and Results: Bleeding complications among 273 consecutive patients undergoing initial ICD implantation were retrospectively analyzed. Patients were grouped according to medication at the time of device implantation: neither antiplatelet nor anticoagulation (N group, n=121); antiplatelet only (AP group, n=59); warfarin (W group, n=59); and heparin bridging (H group, n=34). The rate of the major bleeding complications, defined as hematoma requiring reoperation, cardiac tamponade, and pericardial effusion requiring additional hospital stay, was 1.7% in the N group, 0% in the AP group, 5.1% in the W group, and 17.6% in the H group (P<0.001, N group vs. H group). After multivariate adjustment, heparin bridging was a significant predictor of major bleeding complications (odds ratio, 7.44; 95% confidence interval: 2.06-26.89; P=0.0022). The international normalized ratio of 3 patients in the W group with major bleeding complications was 1.98±0.10, and was significantly higher than in patients without them (1.31±0.05, n=26, P<0.001). Conclusions: Heparin bridging increased the risk of bleeding complications at the time of ICD implantation.
U2 - 10.1253/circj.CJ-12-1507
DO - 10.1253/circj.CJ-12-1507
JO - Circulation Journal
JF - Circulation Journal
10.1253/circj.CJ-12-1507