title: Implantation of cardiac rhythm devices during concomitant anticoagulation or antiplatelet therapy.
abstract: Cardiac rhythm devices are increasingly being utilized as the population ages and the incidence of chronic heart failure, bradyarrhythmias and the indications for pacing and prevention of sudden cardiac arrest expand. The number of patients receiving oral anticoagulants and dual antiplatelet therapy is similarly increasing. Implantation of cardiac rhythm devices during concomitant use of oral anticoagulants or antiplatelet regimens poses an increased risk of perioperative bleeding complications. Traditionally, heparin-based bridging protocols have been recommended for such patients to mitigate the bleeding risk while reducing the risk of thrombotic complications. Although the literature is limited, an appraisal of the literature reveals that bridging may not be the best strategy. We review the literature and propose strategies to promote successful perioperative outcomes, while reducing the risk of bleeding or thrombosis during the time of implantation for patients on chronic anticoagulation and antiplatelet therapies.
authors: Division of Cardiology, University of Utah Health Sciences Center, Salt Lake City, UT, USA.
authors: Alexies
authors: A
authors: Ramirez
authors: T Scott
authors: TS
authors: Wall
authors: Martin
authors: M
authors: Schmidt
authors: Kimberly
authors: K
authors: Selzman
authors: Marcos
authors: M
authors: Daccarett