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Halting anticoagulation after device implantation linked with increased hematomas, thromboembolic events
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Cessation of warfarin with bridging anticoagulation when implanting a pacemaker or defibrillator was associated with a higher incidence of thromboembolic events and other adverse outcomes, study results suggested.
Researchers from several Minnesota institutions retrospectively evaluated 459 patients on chronic warfarin (Coumadin, Bristol-Meyers Squibb) therapy who underwent device surgery between April 2004 and September 2008. During the perioperative period, 222 patients continued taking warfarin. Warfarin was temporarily withheld and bridging therapy administered in 123 patients; a total of 114 patients had warfarin temporarily withheld and had no bridging therapy.
Researchers reported no differences for thromboembolism in the three study groups with regard to age, sex or risk factors. Patients who continued warfarin therapy had a lower incidence of pocket hematoma (P=.004) and shorter hospital stays (P<.0001) vs. patients in the bridging group. Continued warfarin use resulted in a lower incidence of transient ischemic attacks vs. withholding both warfarin and bridging therapy (0% vs. 3.5%, P=.01).
Study limitations included the observational and nonrandomized nature of the data and the possible presence of patient selection bias.
“Implantation of pacemakers and defibrillators in patients on continued warfarin therapy with therapeutic INR appears to be safe and cost effective compared to bridging therapy or temporarily withholding of anticoagulation,” the researchers observed. “These findings need to be confirmed by multicenter, prospective, randomized, controlled studies.”
Ahmed I. Heart Rhythm. 2010; 7:745-749.
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