Prevention of venous thrombosis by warfarin after permanent transvenous leads implantation in high-risk patients.
BACKGROUND
The incidence of venous lesions following transvenous cardiac device implantation is high. Previous implantation of temporary leads ipsilateral to the permanent devices, and a depressed left ventricular ejection fraction have been associated with an increased risk of venous lesions, though the effects of preventive strategies remain controversial. This randomized trial examined the effects of warfarin in the prevention of these complications in high-risk patients.


METHODS
Between February 2004 and September 2007, we studied 101 adults who underwent a first cardiac device implantation, and who had a left ventricular ejection fraction < or =0.40, or a temporary pacing system ipsilateral to the permanent implant, or both. After device implantation, the patients were randomly assigned to warfarin to a target international normalized ratio of 2.0-3.5, or to placebo. Clinical and laboratory evaluations were performed regularly up to 6 months postimplant. Venous lesions were detected at 6 months by digital subtraction venography.


RESULTS
Venous obstructions of various degrees were observed in 46 of the 92 patients (50.0%) who underwent venography. The frequency of venous obstructions was 60.4% in the placebo, versus 38.6% in the warfarin group (P = 0.018), corresponding to an absolute risk reduction of 22% (relative risk = 0.63; 95% confidence interval = 0.013-0.42).


CONCLUSIONS
Warfarin prophylaxis lowered the frequency of venous lesions after transvenous devices implantation in high-risk patients.
Costa
Roberto
R
Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil. rcosta@incor.usp.br
Da Silva
Kátia Regina
KR
Rached
Roberto
R
Martinelli Filho
Martino
M
Carnevale
Francisco César
FC
Moreira
Luiz Felipe Pinho
LF
Stolf
Noedir Antonio Groppo
NA
D000925:Anticoagulants / Q000627:therapeutic use*; D002304:Cardiac Pacing, Artificial / Q000009:adverse effects; D015897:Comorbidity; D017147:Defibrillators, Implantable / Q000009:adverse effects; D004566:Electrodes / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial / Q000009:adverse effects; D010690:Phlebography; D012307:Risk Factors; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D014859:Warfarin / Q000008:administration & dosage / Q000627:therapeutic use*
D000925:Anticoagulants; D014859:Warfarin