Randomized comparison of aspirin and phenprocoumon for prevention of right-sided thromboembolic complications associated with transvenous defibrillation leads
| Autor: | Andreas Hagendorff, W. Fehske, Matthias Manz, H. J. Biersack, H. Omran, Berndt Lüderitz, Werner Jung |
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| Rok vydání: | 1995 |
| Předmět: |
Adult
Male Heart disease Defibrillation medicine.medical_treatment Drug Administration Schedule Phenprocoumon Thromboembolism Antithrombotic medicine Humans Prospective Studies Aged Cerebral Hemorrhage Aspirin Dose-Response Relationship Drug business.industry Vascular disease Middle Aged medicine.disease Thrombosis Defibrillators Implantable Electrodes Implanted Pulmonary embolism Echocardiography Anesthesia Equipment Failure Female Blood Coagulation Tests Cardiology and Cardiovascular Medicine business Follow-Up Studies medicine.drug |
| Zdroj: | European Heart Journal. 16:986-992 |
| ISSN: | 1522-9645 0195-668X |
| DOI: | 10.1093/oxfordjournals.eurheartj.a061035 |
| Popis: | Death due to pulmonary embolism caused by thrombosis formation along a pacing wire has been reported in patients with antibradycardia pacemakers. The purpose of this prospective and randomized study was to evaluate the effects of prophylactically assigned aspirin (100 mg per day) or phenprocoumon (a coumarin derivative) on the incidence of right-sided thromboembolic complications associated with transvenous defibrillation leads. Multiplane transoesophageal echocardiography and pulmonary scintigraphy were performed in 62 consecutive patients immediately and 6 ± 2 months after transvenous defibrillator implantation. Aspirin or phenprocoumon was administered to the patients in a randomized and parallel manner. By means of multiplane transoesophageal echocardiography and pulmonary scintigraphy no thromboembolic events were observed immediately after transvenous defibrillator implantation. After 6 ± 2 months, however, multiplane transoesophageal echocardiography disclosed thrombi on the transvenous leads in 13 of 62 patients (21%) despite antithrombotic therapy. At the same time, pulmonary scintigraphy did not reveal any defects compatible with pulmonary embolism. Although thrombi occurred in only four patients treated with phenprocoumon, but in nine patients receiving aspirin, this difference was statistically insignificant. Other variables associated with the occurrence of thrombosis formation were not identified. One fatal intracranial haemorrhage occurred in the phenprocoumon group. These findings suggest that pulmonary embolism was effectively prevented, but thrombosis formation associated with transvenous defibrillation leads occurred in a significant number of patients despite antithrombotic therapy. A carefully balanced medical decision is required to determine whether the tendency toward a higher prevention of thrombosis formation related to the use of phenprocoumon will actually outweigh the inherent risk of major bleeding events. |
| Databáze: | OpenAIRE |
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