[Hemorrhagic risk of different perioperative anticoagulation protocols in patients implanted with a cardiac pacemaker or defibrillator: retrospective analysis in patients implanted in a community hospital].
OBJECTIVE
Perioperative management of anticoagulation in patients referred for pacemaker or cardiac defibrillator implantation isn't consensual. Our objective was to evaluate, in a large cohort, hemorrhagic complications in patients having implantation or replacement of a cardiac pacemaker or defibrillator, and to assess perioperative anticoagulation effect on hemorrhagic risk.


RESULTS
A cohort of 461 consecutive patients having implantation or replacement of a cardiac pacemaker or defibrillator has been analyzed. Thirty patients (6,5%) had oral anticoagulants (OAC) switched to heparin/low-molecular-weight heparin, while 76 (16,5%) had their oral anticoagulation disrupted habitually for 48 hours. A total of six over 30 (20%) and two over 76 (2.6%) patients in the bridge and OAC, respectively experienced a pocket hematoma (bridge vs. OAC, p<0.05), while ten over 355 (2.8%) had a pocket hematoma in the control group (bridge vs. control p=0.006). Duration of the hospital stay was longer in the bridge group in comparison with OAC and control groups (9 vs. 7 vs. 6 days, respectively, p=0.006).


CONCLUSIONS
Oral anticoagulation bridging with heparin or low-molecular-weight heparin is associated with a higher risk of pocket hematoma and a longer duration of hospitalization, in comparison with a strategy allowing a temporary disruption of OAC adapted to the thromboembolic risk.
Amara
W
W
Service de Cardiologie, GHI Le Raincy-Montfermeil, Montfermeil, France. walamara@yahoo.fr
Ben Youssef
I
I
Kamel
J
J
Ghrissi
I
I
Faron
M
M
Khouadja
A
A
Sergent
J
J
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects*; D002985:Clinical Protocols; D017147:Defibrillators, Implantable; D006406:Hematoma / Q000139:chemically induced*; D006470:Hemorrhage / Q000453:epidemiology*; D006764:Hospitals, Community; D006801:Humans; D008875:Middle Aged; D010138:Pacemaker, Artificial; D019990:Perioperative Care; D012189:Retrospective Studies; D012307:Risk Factors
D000925:Anticoagulants