title: Perioperative anticoagulation for patients with mechanic heart valve(s) undertaking pacemaker implantation.
abstract: OBJECTIVE
  This study was to evaluate perioperative anticoagulation therapy in patients with mechanic heart valve(s) undergoing pacemaker implantation.
  
  
  RESULTS
  A total of 109 patients with mechanical heart valve(s) undertaking pacemaker implantation were studied. Fifty-one patients with warfarin suspended 3 days before surgery were classified into Group 1 and 58 patients with warfarin suspended <3 days or not at all into Group 2. The perioperative incidence of complications was compared. Suspension of warfarin<3 days before surgery was associated with a higher incidence of excessive haemorrhage (16/51 vs. 5/58, P=0.003). Patients with pocket haematoma were more likely to have been treated with post-operation heparin (60% vs. 17.3%, P=0.032). In 42 patients treated with proposed protocol of perioperative anticoagulation, no pocket haematoma or embolism occurred.
  
  
  CONCLUSIONS
  A minimum of 3 days cessation of warfarin prior to surgery is preferred. Low-molecular-weight heparin should not be used for at least 3 days post-surgery. We propose that the protocol of perioperative anticoagulation be a suspension of warfarin not <3 days with low-molecular-weight heparin bridging stopped 12 h before surgery, and warfarin rather than low-molecular-weight heparin initiated immediately after surgery.
authors: Clinical EP. Lab and Arrhythmia Center, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Beijing 100037, China.
authors: Min
authors: M
authors: Cheng
authors: Wei
authors: W
authors: Hua
authors: Keping
authors: K
authors: Chen
authors: Jielin
authors: J
authors: Pu
authors: Xiaoqing
authors: X
authors: Ren
authors: Xinran
authors: X
authors: Zhao
authors: Zhimin
authors: Z
authors: Liu
authors: Fangzheng
authors: F
authors: Wang
authors: Xin
authors: X
authors: Chen
authors: Shu
authors: S
authors: Zhang
mesh_terms: D000284:Administration, Oral; D000925:Anticoagulants / Q000008:administration & dosage*; D005260:Female; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D019990:Perioperative Care; D011292:Premedication / Q000379:methods*; D019919:Prosthesis Implantation / Q000009:adverse effects*; D013923:Thromboembolism / Q000209:etiology* / Q000517:prevention & control*; D016896:Treatment Outcome; D014859:Warfarin / Q000008:administration & dosage*
chemical_list: D000925:Anticoagulants; D014859:Warfarin