title: Implanting cardiac rhythm devices during uninterrupted warfarin therapy: a prospective, single center experience.
abstract: OBJECTIVE
  The aim of the present study was to assess the safety of cardiac rhythm device implantation during uninterrupted oral anticoagulant therapy.
  
  
  METHODS
  Patients at high thromboembolic risk (venous thromboembolism <3 months, nonvalvular atrial fibrillation with CHADS2 score >2, valvular atrial fibrillation, prosthetic heart valves) underwent procedures during uninterrupted warfarin (on warfarin group) and were compared to low-risk patients who underwent procedures after warfarin withdrawal (off warfarin group). Primary endpoint was a composite of hematoma requiring warfarin interruption, reoperation, or blood transfusion; death; hemothorax; and tamponade. Secondary endpoints were nonsignificant hematoma and clinical arterial thromboembolism assessed at discharge and at a 2 month follow-up.
  
  
  RESULTS
  One hundred and ninety-one patients were enrolled, 102 in the 'on warfarin group' and 89 in the 'off warfarin group'. The majority of procedures were first implants (73% in the 'on warfarin group' vs. 87% in the 'off warfarin group', P= 0.01). Pacemakers, implantable cardioverter defibrillators, and biventricular devices were included. International normalized ratio at implant was 2 ± 0.28 (range 1.6-3.2) in the 'on warfarin group' and 1.3 ± 0.19 (range 1-1.6) in the 'off warfarin group' (P= 0.0001). Incidence of hemathoma was five of 102 in the 'on warfarin group' vs. three of 89 in the 'off warfarin group' (5 vs. 3%, P = not significant) and all hemathomas resolved spontaneously. There were no significant hemathomas in either group. There was no death, hemothorax, or tamponade. There were no thromboembolic events at 2 months.
  
  
  CONCLUSIONS
  Cardiac rhythm device implantation during uninterrupted warfarin was not associated with increased bleeding compared with warfarin interruption.
authors.affiliation: aDivision of Cardiology, Ospedale Civile di Treviso 'Ca' Foncello', Treviso bDivision of Cardiology, Ospedale di Cesena 'Bufalini', Cesena, Italy.
authors.forename: Martino
authors.initials: M
authors.lastname: Crosato
authors.forename: Vittorio
authors.initials: V
authors.lastname: Calzolari
authors.forename: Enrico
authors.initials: E
authors.lastname: Franceschini Grisolia
authors.forename: Alessandro
authors.initials: A
authors.lastname: Daniotti
authors.forename: Ferdinando
authors.initials: F
authors.lastname: Baldessin
authors.forename: Roberto
authors.initials: R
authors.lastname: Mantovan
authors.forename: Zoran
authors.initials: Z
authors.lastname: Olivari
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects*; D017147:Defibrillators, Implantable; D004334:Drug Administration Schedule; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006406:Hematoma / Q000139:chemically induced; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D019990:Perioperative Care / Q000379:methods*; D019106:Postoperative Hemorrhage / Q000139:chemically induced; D011446:Prospective Studies; D019919:Prosthesis Implantation / Q000009:adverse effects / Q000379:methods; D013923:Thromboembolism / Q000517:prevention & control; D014859:Warfarin / Q000008:administration & dosage / Q000009:adverse effects*
chemical_list: D000925:Anticoagulants; D014859:Warfarin