Pacemaker and implantable cardioverter defibrillator implantation without reversal of warfarin therapy.
The study evaluated all patients undergoing permanent pacemaker and ICD implantation over a 4-year period to determine if anticoagulated patients required normalization of coagulation factors in the periprocedural period. The study included 1,025 (597 men, 428 women, age 24-100 years, mean 72 years) consecutive patients who underwent device implantation using mostly a percutaneous subclavian approach. The procedures were performed without reversal of anticoagulation in 470 patients with INRs >or= 1.5 at the time of the procedure (mean INR 2.6 +/- 1.0, range 1.5-7.5). The complication rate in the anticoagulated group was similar to those in patients with a normal INR. Routine normalization of coagulation factors prior to pacemaker/ICD placement may not be necessary.
Division of Cardiology, Genesis Medical Center, Davenport, Iowa 52803, USA. giudici@cvmedpc.com
Michael C
MC
Giudici
Deborah L
DL
Paul
Praveen
P
Bontu
S Serge
SS
Barold
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D006328:Cardiac Catheterization; D017147:Defibrillators, Implantable; D005260:Female; D005500:Follow-Up Studies; D006406:Hematoma / Q000209:etiology; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D011183:Postoperative Complications; D019919:Prosthesis Implantation; D012189:Retrospective Studies; D013350:Subclavian Vein; D014859:Warfarin / Q000627:therapeutic use*
D000925:Anticoagulants; D014859:Warfarin; D006493:Heparin