Anticoagulation management in patients with mechanical heart valves having pacemaker or defibrillator insertion

被引:1
作者
Schulman, S. [1 ,2 ,5 ]
Schoenberg, J. [2 ]
Menon, S. Divakara [3 ]
Spyropoulos, A. C. [1 ,2 ]
Healey, J. S. [4 ]
Eikelboom, J. W. [1 ,2 ,4 ]
机构
[1] McMaster Univ, Thrombosis & Atherosclerosis Res Inst, Hamilton, ON, Canada
[2] McMaster Univ, Dept Med, Thrombosis Serv, Hamilton, ON, Canada
[3] McMaster Univ, Arrhythmia Serv, Hamilton, ON, Canada
[4] McMaster Univ, Populat Hlth Res Inst, Hamilton, ON, Canada
[5] Karolinska Inst, Stockholm, Sweden
关键词
Pacemaker; Defibrillator; Mechanical heart valve; Mitral; Aortic; Anticoagulation; MOLECULAR-WEIGHT HEPARIN; IMPLANTABLE CARDIOVERTER-DEFIBRILLATORS; ORAL ANTICOAGULATION; BLEEDING COMPLICATIONS; RANDOMIZED-TRIAL; THERAPY; SURGERY; MORBIDITY; HEMATOMA; INCREASE;
D O I
10.1016/j.thromres.2013.01.012
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: In patients with a high risk for stroke and having invasive procedures with a high risk for bleeding it is unclear how anticoagulant therapy should be managed. Methods: We reviewed data from all patients with mechanical heart valves, who had elective insertion or replacement of pacemaker or implantable cardioverter defibrillator (ICD) during the past 8 years at our hospital. Data on anticoagulant treatment, pocket hematoma and thromboembolic complications were captured. Results: Of the 111 patients reviewed, 68 (61%) had a mechanical valve in the mitral position with or without other valves replaced and 43 (39%) had a mechanical valve only in the aortic position. Fifty-nine (53%) were undergoing replacement for their device. Six patients received a tapered warfarin regimen and 102 received preoperative bridging anticoagulation of whom 12 also received postoperative bridging. One stroke occurred 40 days after pacemaker replacement in a patient with mitral mechanical valve and without postoperative bridging. Six patients (5.5%) developed pocket hematoma without a significant association to postoperative bridging, type of mechanical valve or to type of device. Predictors for pocket hematoma appeared to be replacement surgery (odds ratio 12.5; 95% confidence interval [CI], 0.69-228) and an international normalized ratio of 1.5 or higher on the day of surgery (odds ratio 8.4; 95% CI, 0.96-68.1). Conclusion: We found a low risk for stroke in the absence of postoperative bridging. For patients with device replacement surgery reversal of the anticoagulant effect at the time of procedure might reduce the risk for pocket hematoma, but this requires prospective evaluation including the risk of thromboembolism. (C) 2013 Elsevier Ltd. All rights reserved.
引用
收藏
页码:300 / 303
页数:4
相关论文
共 24 条
[1]   Continuing warfarin therapy is superior to interrupting warfarin with or without bridging anticoagulation therapy in patients undergoing pacemaker and defibrillator implantation [J].
Ahmed, Imdad ;
Gertner, Elie ;
Nelson, William B. ;
House, Chad M. ;
Dahiya, Ranjan ;
Anderson, Christopher P. ;
Benditt, David G. ;
Zhu, Dennis W. X. .
HEART RHYTHM, 2010, 7 (06) :745-749
[2]   Implantation of pacemakers and implantable cardioverter defibrillators in orally anticoagulated patients [J].
Al-Khadra, AS .
PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY, 2003, 26 (01) :511-514
[3]   Evaluation of a new standardized protocol for the perioperative management of chronically anticoagulated patients receiving implantable cardiac arrhythmia devices [J].
Cano, Oscar ;
Munoz, Begona ;
Tejada, David ;
Osca, Joaquin ;
Sancho-Tello, Maria-Jose ;
Olaguee, Jose ;
Castro, Jose E. ;
Salvador, Antonio .
HEART RHYTHM, 2012, 9 (03) :361-367
[4]   Continuation of warfarin during pacemaker or implantable cardioverter-defibrillator implantation: A randomized clinical trial [J].
Cheng, Alan ;
Nazarian, Saman ;
Brinker, Jeffrey A. ;
Tompkins, Christine ;
Spragg, David D. ;
Leng, Charles T. ;
Halperin, Henry ;
Tandri, Harikrishna ;
Sinha, Sunil K. ;
Marine, Joseph E. ;
Calkins, Hugh ;
Tomaselli, Gordon F. ;
Berger, Ronald D. ;
Henrikson, Charles A. .
HEART RHYTHM, 2011, 8 (04) :536-540
[5]   Perioperative anticoagulation for patients with mechanic heart valve(s) undertaking pacemaker implantation [J].
Cheng, Min ;
Hua, Wei ;
Chen, Keping ;
Pu, Jielin ;
Ren, Xiaoqing ;
Zhao, Xinran ;
Liu, Zhimin ;
Wang, Fangzheng ;
Chen, Xin ;
Zhang, Shu .
EUROPACE, 2009, 11 (09) :1183-1187
[6]   Peri-procedural anticoagulation management of mechanical prosthetic heart valve patients [J].
Daniels, Paul R. ;
McBane, Robert D. ;
Litin, Scott C. ;
Ward, Sue A. ;
Hodge, David O. ;
Dowling, Nicole F. ;
Heit, John A. .
THROMBOSIS RESEARCH, 2009, 124 (03) :300-305
[7]  
Denman RA, 1999, CSANZ 47 ANN SCI M
[8]   Perioperative Management of Antithrombotic Therapy Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence- Based Clinical Practice Guidelines [J].
Douketis, James D. ;
Spyropoulos, Alex C. ;
Spencer, Frederick A. ;
Mayr, Michael ;
Jaffer, Amir K. ;
Eckman, Mark H. ;
Dunn, Andrew S. ;
Kunz, Regina .
CHEST, 2012, 141 (02) :E326S-E350S
[9]   Pacemaker and implantable cardioverter defibrillator implantation without reversal of warfarin therapy [J].
Giudici, MC ;
Barold, SS ;
Paul, DL ;
Bontu, P .
PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY, 2004, 27 (03) :358-360
[10]   Outpatient pacemaker procedures in orally anticoagulated patients [J].
Goldstein, DJ ;
Losquadro, W ;
Spotnitz, HM .
PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY, 1998, 21 (09) :1730-1734