Systematic Implantation of Pacemaker/ICDs under Active Oral Anticoagulation Irrespective of Patient's Individual Preoperative Thromboembolic Risk

Autores de IIS La Fe

• Óscar Cano Pérez

  Autor

• Ana Andrés Lahuerta

  Autor

• Rebeca Jimenez Carreño

  Autor

• Joaquín Osca Asensi

  Autor

• Pau Alonso Fernández

  Autor

• Ydelise Mercedes Rodriguez Pichardo

  Autor

• María José Sancho-Tello De Carranza

  Autor

• Jose Olague De Ros

  Autor

• José Enrique Castro Pareja

  Autor

• Antonio Salvador Sanz

  Autor

• 

  Luis Vicente Martínez Dolz

  Autor

Grupos

• Grupo de Investigación Clínica y Traslacional en Cardiología

• Regeneración y Trasplante Cardíaco

Abstract

BackgroundA wide variability in the perioperative management of oral anticoagulation (OAC) has been documented in patients receiving cardiac rhythm management devices (CRMDs). We sought to evaluate the safety and feasibility of a new perioperative strategy consisting in systematically continuing OAC in all patients irrespective of their individual thromboembolic (TE) risk. MethodsA total of 278 consecutive patients on chronic OAC receiving CRMDs were prospectively included. Patients were classified in high and low TE risk according to current guidelines for the perioperative management of antithrombotic therapy, but underwent implantation under active OAC (international normalized ratio 2-4) irrespective of their preoperative TE risk. Bleeding and TE complications were evaluated as well as other procedure-related complications, hospital stays, and the feasibility of outpatient implantations. ResultsA total of 117 patients were considered at high TE risk and 161 at low TE risk. Overall, the incidence of pocket hematoma was 2.9% with only three patients requiring pocket revision. Low TE risk patients had a very low incidence of pocket hematoma (1.9%) without needing pocket revision. The mean hospital stay was 1.17 1.8 days and 169 patients (61%) received their CRMD in an outpatient basis, including 77 patients who were implanted with an implantable cardioverter defibrillator. No TE events were detected during the 30-day postimplant observation period in any patient. No other significant complications related with the implant (pneumothorax, hemothorax, cardiac tamponade) were registered. ConclusionsSystematic continuation of OAC in all patients undergoing implantation of CRMDs is safe and feasible, thus simplifying and standardizing the perioperative management in this setting.

Keywords

• anticoagulants; pacemakers; thromboembolic risk