Perioperative anticoagulation for patients with mechanic heart valve(s) undertaking pacemaker implantation.
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.
Cheng
Min
M
Clinical EP. Lab and Arrhythmia Center, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Beijing 100037, China.
Hua
Wei
W
Chen
Keping
K
Pu
Jielin
J
Ren
Xiaoqing
X
Zhao
Xinran
X
Liu
Zhimin
Z
Wang
Fangzheng
F
Chen
Xin
X
Zhang
Shu
S
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*
D000925:Anticoagulants; D014859:Warfarin