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European Heart Journal Advance Access originally published online on May 31, 2009
European Heart Journal 2009 30(15):1880-1884; doi:10.1093/eurheartj/ehp194
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org
The online version of this article has been published under an open access model. Users are entitled to use, reproduce, disseminate, or display the open access version of this article for non-commercial purposes provided that the original authorship is properly and fully attributed; the Journal, Learned Society and Oxford University Press are attributed as the original place of publication with correct citation details given; if an article is subsequently reproduced or disseminated not in its entirety but only in part or as a derivative work this must be clearly indicated. For commercial re-use, please contact journals.permissions@oxfordjournals.org

Preparation for pacemaker or implantable cardiac defibrillator implants in patients with high risk of thrombo-embolic events: oral anticoagulation or bridging with intravenous heparin? A prospective randomized trial

Jose M. Tolosana1, Paola Berne1, Lluis Mont1,*, Magda Heras1, Antonio Berruezo1, Joan Monteagudo2, David Tamborero1, Begoña Benito1 and Josep Brugada1

1 Cardiology Department, Thorax Institute, Hospital Clinic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)
2 Hemotherapy and Hemostasis Department, Villarroel 170, Barcelona 08036, Catalonia, Spain

Received 7 May 2008; revised 5 March 2009; accepted 28 April 2009; online publish-ahead-of-print 31 May 2009.

* Corresponding author. Tel: +34 932275551, Fax: +34 934513045, Email: lmont{at}clinic.ub.es

Aims: Current guidelines recommend stopping oral anticoagulation (OAC) and starting heparin infusion before implanting/replacing a pacemaker/implantable cardioverter-defibrillator (ICD) in patients with high risk for thrombo-embolic events. The aim of this study was to demonstrate that the maintenance of OAC during device implantation/replacement is as safe as bridging to intravenous heparin and shortens in-hospital stay.

Methods and results: A cohort of 101 consecutive patients with high risk for embolic events and indication for implant/replacement of a pacemaker/ICD were randomized to two anticoagulant strategies: bridging from OAC to heparin infusion (n = 51) vs. maintenance of OAC to reach an INR = 2 ± 0.3 at the day of the procedure (n = 50). Haemorrhagic and thrombo-embolic complications were evaluated at discharge, 15 and 45 days after the procedure. A total of 4/51 patients (7.8%) from heparin group and 4/50 (8.0%) from the OAC group developed pocket haematoma following the implant (P = 1.00). One haematoma in each group required evacuation (1.9 vs. 2%, P = 1.00). No other haemorrhagic events or embolic complications developed during the follow-up. Duration of the hospital stay was longer in the heparin group [median of 5 (4–7) vs. 2 (1–4) days; P < 0.001].

Conclusion: Implant of devices maintaining OAC is as safe as bridging to heparin infusion and allows a significant reduction of in-hospital stay.

Key Words: Pacemaker • Mechanical prosthetic valve • Atrial fibrillation • Pocket haematoma • Thrombo-embolism


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J.-C. Daubert and P. Mabo
Continue or withhold oral anticoagulation in high-risk patients undergoing pacemaker or ICD implantation
Eur. Heart J., August 28, 2009; (2009) ehn491v1.
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