Implanting cardiac rhythm devices during uninterrupted warfarin therapy
| Autor: | Ferdinando Baldessin, Alessandro Daniotti, Enrico Franceschini Grisolia, Martino Crosato, Roberto Mantovan, Vittorio Calzolari, Zoran Olivari |
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| Rok vydání: | 2015 |
| Předmět: |
Male
Pacemaker Artificial medicine.medical_specialty Blood transfusion medicine.medical_treatment Postoperative Hemorrhage Single Center Drug Administration Schedule Perioperative Care Prosthesis Implantation Hematoma Thromboembolism medicine Clinical endpoint Humans heterocyclic compounds Prospective Studies cardiovascular diseases Aged Aged 80 and over business.industry Warfarin Anticoagulants Atrial fibrillation General Medicine Middle Aged medicine.disease Hemothorax Defibrillators Implantable Surgery Feasibility Studies Female Tamponade Cardiology and Cardiovascular Medicine business Follow-Up Studies medicine.drug |
| Zdroj: | Journal of Cardiovascular Medicine. 16:503-506 |
| ISSN: | 1558-2027 |
| DOI: | 10.2459/jcm.0000000000000011 |
| Popis: | The aim of the present study was to assess the safety of cardiac rhythm device implantation during uninterrupted oral anticoagulant therapy.Patients at high thromboembolic risk (venous thromboembolism3 months, nonvalvular atrial fibrillation with CHADS2 score2, valvular atrial fibrillation, prosthetic heart valves) underwent procedures during uninterrupted warfarin (on warfarin group) and were compared to low-risk patients who underwent procedures after warfarin withdrawal (off warfarin group). Primary endpoint was a composite of hematoma requiring warfarin interruption, reoperation, or blood transfusion; death; hemothorax; and tamponade. Secondary endpoints were nonsignificant hematoma and clinical arterial thromboembolism assessed at discharge and at a 2 month follow-up.One hundred and ninety-one patients were enrolled, 102 in the 'on warfarin group' and 89 in the 'off warfarin group'. The majority of procedures were first implants (73% in the 'on warfarin group' vs. 87% in the 'off warfarin group', P= 0.01). Pacemakers, implantable cardioverter defibrillators, and biventricular devices were included. International normalized ratio at implant was 2 ± 0.28 (range 1.6-3.2) in the 'on warfarin group' and 1.3 ± 0.19 (range 1-1.6) in the 'off warfarin group' (P= 0.0001). Incidence of hemathoma was five of 102 in the 'on warfarin group' vs. three of 89 in the 'off warfarin group' (5 vs. 3%, P = not significant) and all hemathomas resolved spontaneously. There were no significant hemathomas in either group. There was no death, hemothorax, or tamponade. There were no thromboembolic events at 2 months.Cardiac rhythm device implantation during uninterrupted warfarin was not associated with increased bleeding compared with warfarin interruption. |
| Databáze: | OpenAIRE |
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