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Implanting cardiac rhythm devices during uninterrupted warfarin therapy: a prospective, single center experience

Crosato, Martino; Calzolari, Vittorio; Franceschini Grisolia, Enrico; Daniotti, Alessandro; Baldessin, Ferdinando; Mantovan, Roberto; Olivari, Zoran

Journal of Cardiovascular Medicine: July 2015 - Volume 16 - Issue 7 - p 503–506
doi: 10.2459/JCM.0000000000000011
Anticoagulation: Original articles
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Aim The aim of the present study was to assess the safety of cardiac rhythm device implantation during uninterrupted oral anticoagulant therapy.

Methods Patients at high thromboembolic risk (venous thromboembolism <3 months, nonvalvular atrial fibrillation with CHADS2 score >2, 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.

Results 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.

Conclusion Cardiac rhythm device implantation during uninterrupted warfarin was not associated with increased bleeding compared with warfarin interruption.

aDivision of Cardiology, Ospedale Civile di Treviso ‘Ca’ Foncello’, Treviso

bDivision of Cardiology, Ospedale di Cesena ‘Bufalini’, Cesena, Italy

Correspondence to Martino Crosato, Division of Cardiology, Ospedale Civile di Treviso ‘Ca’ Foncello’, 31100 Treviso, Italy Tel: +39 0 422322767; fax: +39 0 422322662; e-mail: elenamartinocrosato@gmailcom

Received 10 December, 2013

Revised 20 January, 2014

Accepted 20 January, 2014

© 2015 Italian Federation of Cardiology. All rights reserved.