Implantation of Pacemakers and Implantable Cardioverter Defibrillators in Orally Anticoagulated Patients

Abstract

The safety of pacemaker and defibrillator implantations in orally anticoagulated patients using standard techniques has not been thoroughly evaluated. This article describes a prospectively collected experience in such patients. Patients presenting for device implantation who were treated with warfarin were allowed to continue therapy provided that the INR was < 3.5. Implantations involved cannulation of the left axillary vein. Except for defibrillator leads, 7 Fr introducers were used, and all were leads actively fixated. The study included 47 patients who underwent implantation of permanent pacemakers (n = 39), defibrillators (n = 5), or biventricular pacemakers (n = 3). The mean INR was 2.3. The primary indication for anticoagulation was a mechanical cardiac prosthesis in 11 (24%) patients. Atrial fibrillation was present in 33 patients. There were no instances of major bleeding or hematomas requiring evacuation. One patient had a small soft hematoma, which resolved spontaneously. At 6 weeks, all patients had well-healed scars with satisfactory pacing and sensing thresholds. In experienced centers, patients requiring treatment with warfarin may undergo implantation of pacemakers or defibrillators with minimal risk despite continuation of anticoagulation.

Anticoagulation of patients on chronic warfarin undergoing arrhythmia device surgery: Wide variability of perioperative bridging in Canada

“…2,11,14 Strategically, an ongoing warfarin approach shifts the potential risk of adverse outcomes toward bleeding and away from thrombosis in the perioperative period. Conceptually, the high bleeding risk is present during surgery in patients who remain on warfarin, facilitating immediate recognition and therefore appropriate management of ongoing bleeding.…”

“…1,9 -13 Conversely, safe implantation of devices without interruption of warfarin has been reported. 2,11,14 In the absence of clinical trials to guide practice, we sought to determine the perioperative anticoagulation strategies currently used in Canada to guide the design of a prospective randomized trial.…”

Clinical analysis of the effect of anti-allergy treatment on pocket-related complications following pacemaker implantation

“…The present findings suggested that pocket effusion or hematoma caused by an allergic reaction was more serious and harmful when compared with pocket effusion or hematoma caused by other risk factors. Furthermore, previous studies have indicated that no effective treatment for pocket hematoma has been discovered (2–5). …”

“…These complications are associated with prolonged hospitalization, increased hospital charges, slow wound healing, typically result in re-operation and may cause surgery failure (3,4). Furthermore, hematoma may increase the risk of infection and cause endocarditis (3–5). Therefore, whether pocket hematoma may be prevented and treated would affect the success of pacemaker surgery.…”

Periprocedural management of anticoagulation and antiplatelet therapies in patients undergoing electrophysiologic procedures

“…This study strongly supports the association of early heparin use with bleeding complications. • Al-Khadra [34] described a series of 47 patients in whom implantation of a pacemaker or ICD was accomplished with uninterrupted oral anticoagulation. In this series, there were no instances of major bleeding or device-related complications.…”