title: [Management of antithrombotic therapy in patients undergoing implantation or replacement of cardiac implantable electronic devices].
abstract: In Italy tens of thousands of patients undergo implantation or replacement of cardiac implantable electronic devices (CIEDs) annually, and up to 50% of these subjects receive antiplatelet agents or oral anticoagulants. The rate of CIED-related complications, mainly infective, has also significantly increased, so that transvenous lead extraction procedures are often required. CIED surgery is peculiar and portends specific intrinsic risks of developing life-threatening hemorrhagic complications; on the other hand periprocedural discontinuation of antithrombotic therapy in patients at high thromboembolic risk may have catastrophic consequences. Accordingly, the management of candidates to CIED surgery who receive concomitant antithrombotic therapy is of great clinical relevance, though controversial and only partially, if not at all, adequately addressed in current evidence-based guidelines. Although for many procedures the administration of aspirin alone or continuation of anticoagulant therapy seems reasonably safe, with use of bridging therapy with parenteral heparins restricted to selected cases, there are multiple variables that may make therapeutic choices challenging. The aim of the present position paper is to provide practical recommendations for the management of antithrombotic therapy in patients undergoing CIED surgery by defining indications for a systematic approach integrating general technical considerations with patient-specific elements based on a careful evaluation of the balance between hemorrhagic and thromboembolic risk. The decision-making process applied in this document relies on the stratification of the procedural hemorrhagic risk and of the risk deriving from discontinuation of antiplatelet or anticoagulant therapy combined to produce different clinical scenarios with specific indications for optimal management of periprocedural antithrombotic therapy.
authors: Valerio
authors: V
authors: Zacà
authors: Rossella
authors: R
authors: Marcucci
authors: Guido
authors: G
authors: Parodi
authors: Ugo
authors: U
authors: Limbruno
authors: Pasquale
authors: P
authors: Notarstefano
authors: Paolo
authors: P
authors: Pieragnoli
authors: Andrea
authors: A
authors: Di Cori
authors: Maria Grazia
authors: MG
authors: Bongiorni
authors: Giancarlo
authors: G
authors: Casolo
mesh_terms: D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D003657:Decision Making; D017147:Defibrillators, Implantable; D006470:Hemorrhage / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D010138:Pacemaker, Artificial; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D017410:Practice Guidelines as Topic; D012306:Risk; D015607:Stents; D013923:Thromboembolism / Q000209:etiology / Q000517:prevention & control
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors