Perioperative management of oral anticoagulation in patients undergoing implantation of subcutaneous implantable cardioverter-defibrillator

Afzal, Muhammad R.; Mehta, Divyesh; Evenson, Christopher; Pinkhas, Daniel; Badin, Auroa; Patel, Darshan; Essandoh, Michael; Godara, Hemant; Tyler, Jaret; Houmsse, Mahmoud; Liu, Zhenguo; Kalbfleisch, Steven J.; Hummel, John D.; Augostini, Ralph; Weiss, Raul; Daoud, Emile G.; Okabe, Toshimasa

doi:10.1016/j.hrthm.2017.11.010

Cited by 12 publications

(16 citation statements)

References 12 publications

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“…This study expands on the findings of Azfal et al. in a larger two‐center population while addressing the risk of pocket hematoma with perioperative bridging AC, DOACs, and AP therapy …”

Section: Discussionsupporting

confidence: 52%

“…This study reports a high rate of hematoma which may be due to increased AC and AP usage, comorbidities, less surgical procoagulant usage, differences in the threshold for hematoma evacuation, and the possibility of underreporting of hematoma in prior studies. Of note, a similarly elevated risk for hematoma (5.8%) was reported during a recent single‐center S‐ICD cohort that included many patients on uninterrupted warfarin …”

Section: Discussionmentioning

confidence: 62%

“…It can also result in prolonged hospitalizations and readmissions with associated risks. The reported incidence of hematoma complicating S‐ICD implantation is 0.2–5.8% (Table ) . This study reports a high rate of hematoma which may be due to increased AC and AP usage, comorbidities, less surgical procoagulant usage, differences in the threshold for hematoma evacuation, and the possibility of underreporting of hematoma in prior studies.…”

Section: Discussionmentioning

confidence: 68%

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Perioperative hematoma with subcutaneous ICD implantation: Impact of anticoagulation and antiplatelet therapies

Sheldon

Cunnane

Lavu

et al. 2018

Pacing Clinical Electrophis

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“…This study expands on the findings of Azfal et al. in a larger two‐center population while addressing the risk of pocket hematoma with perioperative bridging AC, DOACs, and AP therapy …”

Section: Discussionsupporting

confidence: 52%

Section: Discussionmentioning

confidence: 62%

Section: Discussionmentioning

confidence: 68%

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Perioperative hematoma with subcutaneous ICD implantation: Impact of anticoagulation and antiplatelet therapies

Sheldon

Cunnane

Lavu

et al. 2018

Pacing Clinical Electrophis

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“…In both cases, the device was secured to the fascia covering the serratus anterior muscle. Parasternal incisions were also made in the standard fashion as described earlier …”

Section: Methodsmentioning

confidence: 99%

“…Perioperative cardiovascular medications including beta‐blockers, diuretics, and antiplatelet agents were continued without any interruption. Management of perioperative anticoagulation was according to the institutional protocol as described previously . Briefly, all direct oral anticoagulants were withheld 2 days prior to the procedure.…”

Section: Methodsmentioning

confidence: 99%

Implantation of subcutaneous defibrillator is feasible and safe with monitored anesthesia care

Afzal

Okabe

Koppert³

et al. 2019

Pacing Clinical Electrophis

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Background The perioperative anesthesia care during subcutaneous implantable cardioverter‐defibrillator (S‐ICD) implantation is still evolving. Objective To assess the feasibility and safety of S‐ICD implantation with monitored anesthesia care (MAC) versus general anesthesia (GA) in a tertiary care center. Methods This is a single‐center retrospective study of patients undergoing S‐ICD implantation between October 2012 and May 2019. Patients were categorized into MAC and GA group based on the mode of anesthesia. Procedural success without escalation to GA was the primary endpoint of the study, whereas intraprocedural hemodynamics, need of pharmacological support for hypotension and bradycardia, length of the procedure, stay in the post‐anesthesia care unit, and postoperative pain were assessed as secondary endpoints. Results The study comprises 287 patients with MAC in 111 and GA in 176 patients. Compared to MAC, patients in GA group were younger and had a higher body mass index. All patients had successful S‐ICD implantation. Only one patient (0.9%) in the MAC group was converted to GA. Despite a similar baseline heart rate (HR) and mean arterial blood pressure (MAP) in both groups, patients with GA had significantly lower HR and MAP during the procedure and more frequently required pharmacological hemodynamic support. Length of the procedure, stay in the postanesthesia care unit, and postoperative pain was similar in both groups. Conclusion This retrospective experience suggests that implantation of S‐ICD is feasible and safe with MAC. Use of GA is associated with more frequent administration of hemodynamic drugs during S‐ICD implantation.

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Conscious sedation during subcutaneous implantable cardioverter-defibrillator implantation using the intermuscular technique

Kaya

Jánosi

Azizy

et al. 2018

J Interv Card Electrophysiol

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Perioperative management of oral anticoagulation in patients undergoing implantation of subcutaneous implantable cardioverter-defibrillator

Cited by 12 publications

References 12 publications

Perioperative hematoma with subcutaneous ICD implantation: Impact of anticoagulation and antiplatelet therapies

Perioperative hematoma with subcutaneous ICD implantation: Impact of anticoagulation and antiplatelet therapies

Implantation of subcutaneous defibrillator is feasible and safe with monitored anesthesia care

Conscious sedation during subcutaneous implantable cardioverter-defibrillator implantation using the intermuscular technique

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