title: Anticoagulation management in the perioperative phase of implantable cardioverter defibrillator implantation.
abstract: BACKGROUND
  According to the current guidelines, substitution of warfarin with heparin is recommended as perioperative management in patients with high risk of thromboembolism. Optimal management of oral anticoagulation in patients undergoing implantable cardioverter defibrillator (ICD) implantation, however, remains controversial.
  
  
  RESULTS
  Bleeding complications among 273 consecutive patients undergoing initial ICD implantation were retrospectively analyzed. Patients were grouped according to medication at the time of device implantation: neither antiplatelet nor anticoagulation (N group, n=121); antiplatelet only (AP group, n=59); warfarin (W group, n=59); and heparin bridging (H group, n=34). The rate of the major bleeding complications, defined as hematoma requiring reoperation, cardiac tamponade, and pericardial effusion requiring additional hospital stay, was 1.7% in the N group, 0% in the AP group, 5.1% in the W group, and 17.6% in the H group (P<0.001, N group vs. H group). After multivariate adjustment, heparin bridging was a significant predictor of major bleeding complications (odds ratio, 7.44; 95% confidence interval: 2.06-26.89; P=0.0022). The international normalized ratio of 3 patients in the W group with major bleeding complications was 1.98 ± 0.10, and was significantly higher than in patients without them (1.31 ± 0.05, n=26, P<0.001).
  
  
  CONCLUSIONS
  Heparin bridging increased the risk of bleeding complications at the time of ICD implantation.
authors.affiliation: Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo 060-8638, Japan. yokoshh@med.hokudai.ac.jp
authors.forename: Hisashi
authors.initials: H
authors.lastname: Yokoshiki
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Mitsuyama
authors.forename: Masaya
authors.initials: M
authors.lastname: Watanabe
authors.forename: Kazuya
authors.initials: K
authors.lastname: Mizukami
authors.forename: Yoshiro
authors.initials: Y
authors.lastname: Matsui
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Tsutsui
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects*; D017147:Defibrillators, Implantable; D005260:Female; D006470:Hemorrhage / Q000453:epidemiology / Q000209:etiology; D006493:Heparin / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D014859:Warfarin / Q000008:administration & dosage / Q000009:adverse effects
chemical_list: D000925:Anticoagulants; D014859:Warfarin; D006493:Heparin