Anticoagulant therapy during cardiovascular implantable electronic device procedures

Abstract

Aim The objective of the study is to systematically evaluate the safety and efficacy of peri-procedural utilization of anticoagulation therapy during cardiovascular implantable electronic device procedures. Material and methods The review materials were based on comprehensive retrieval of randomized controlled trials and observational studies published until April 2023. Studies which compared different management strategies of long-term anticoagulation therapy during peri-procedural cardiac rhythm device implantation and compared the complications of bleeding and/or thromboembolic events were selected and reviewed. Results Studies analysing non-vitamin K oral anticoagulants interruption versus continuation during peri-procedural implantable cardiac device surgery found no statistically significant difference in bleeding or thromboembolic complications between these strategies. Studies comparing non-vitamin K oral anticoagulants with vitamin K antagonists also showed no statistically significant difference. One study comparing uninterrupted warfarin with interrupted warfarin with heparin bridging reported a reduced incidence of clinically significant device pocket haematoma in patients with continued warfarin treatment (relative risk = 0.19; 95% confidence interval: 0.10 to 0.36; p < 0.001). A sub-analysis of one study comparing dabigatran versus warfarin with heparin bridging and without bridging reported a lower risk of pocket haematoma with dabigatran when compared to warfarin with heparin bridging (risk difference: –8.62%, 95% confidence interval: –24.15 to –0.51%; p = 0.034). Both bleeding and thromboembolic complications were rare. Conclusions The traditional method of vitamin K antagonists interruption with heparin bridging is less safe than continuing vitamin K antagonists at therapeutic levels. Both continuation and interruption strategies of non-vitamin K anticoagulants during cardiac device surgery seem to be safe and appropriate.

Factors of mortality in patients with cardiac implantable electronic device: 5-year experience

“…Previously, 0.9% of the participants in the unmedicated group had hematoma, while 5.5 and 5.6% of the ASA and NOAC groups had hematoma, respectively. In addition, with dual antiplatelet treatment, the incidence of hematoma increased up to five times 13 . Warfarin users have discontinued using heparin-bridging strategies because of the heightened danger of hemorrhage.…”