title: 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.
abstract: OBJECTIVE
  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.
  
  
  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].
  
  
  CONCLUSIONS
  Implant of devices maintaining OAC is as safe as bridging to heparin infusion and allows a significant reduction of in-hospital stay.
authors.affiliation: Cardiology Department, Thorax Institute, Hospital Clinic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona 08036, Catalonia, Spain
authors.forename: Jose M
authors.initials: JM
authors.lastname: Tolosana
authors.forename: Paola
authors.initials: P
authors.lastname: Berne
authors.forename: Lluis
authors.initials: L
authors.lastname: Mont
authors.forename: Magda
authors.initials: M
authors.lastname: Heras
authors.forename: Antonio
authors.initials: A
authors.lastname: Berruezo
authors.forename: Joan
authors.initials: J
authors.lastname: Monteagudo
authors.forename: David
authors.initials: D
authors.lastname: Tamborero
authors.forename: Begoña
authors.initials: B
authors.lastname: Benito
authors.forename: Josep
authors.initials: J
authors.lastname: Brugada
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D017147:Defibrillators, Implantable; D004617:Embolism / Q000517:prevention & control* / Q000628:therapy; D005260:Female; D006493:Heparin / Q000627:therapeutic use*; D006801:Humans; D007902:Length of Stay; D008297:Male; D010138:Pacemaker, Artificial; D017410:Practice Guidelines as Topic; D011292:Premedication / Q000379:methods*; D011446:Prospective Studies
chemical_list: D000925:Anticoagulants; D006493:Heparin