title: Systematic Implantation of Pacemaker/ICDs under Active Oral Anticoagulation Irrespective of Patient's Individual Preoperative Thromboembolic Risk.
abstract: BACKGROUND
  A wide variability in the perioperative management of oral anticoagulation (OAC) has been documented in patients receiving cardiac rhythm management devices (CRMDs). We sought to evaluate the safety and feasibility of a new perioperative strategy consisting in systematically continuing OAC in all patients irrespective of their individual thromboembolic (TE) risk.
  
  
  METHODS
  A total of 278 consecutive patients on chronic OAC receiving CRMDs were prospectively included. Patients were classified in high and low TE risk according to current guidelines for the perioperative management of antithrombotic therapy, but underwent implantation under active OAC (international normalized ratio 2-4) irrespective of their preoperative TE risk. Bleeding and TE complications were evaluated as well as other procedure-related complications, hospital stays, and the feasibility of outpatient implantations.
  
  
  RESULTS
  A total of 117 patients were considered at high TE risk and 161 at low TE risk. Overall, the incidence of pocket hematoma was 2.9% with only three patients requiring pocket revision. Low TE risk patients had a very low incidence of pocket hematoma (1.9%) without needing pocket revision. The mean hospital stay was 1.17 ± 1.8 days and 169 patients (61%) received their CRMD in an outpatient basis, including 77 patients who were implanted with an implantable cardioverter defibrillator. No TE events were detected during the 30-day postimplant observation period in any patient. No other significant complications related with the implant (pneumothorax, hemothorax, cardiac tamponade) were registered.
  
  
  CONCLUSIONS
  Systematic continuation of OAC in all patients undergoing implantation of CRMDs is safe and feasible, thus simplifying and standardizing the perioperative management in this setting.
authors: Electrophysiology Section, Cardiology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain.|Instituto Investigación Sanitaria La Fe, Valencia, Spain.
authors: Óscar
authors: Ó
authors: Cano
authors: Electrophysiology Section, Cardiology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain.|Instituto Investigación Sanitaria La Fe, Valencia, Spain.
authors: Ana
authors: A
authors: Andrés
authors: Electrophysiology Section, Cardiology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain.
authors: Rebeca
authors: R
authors: Jiménez
authors: Electrophysiology Section, Cardiology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain.
authors: Joaquín
authors: J
authors: Osca
authors: Electrophysiology Section, Cardiology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain.|Instituto Investigación Sanitaria La Fe, Valencia, Spain.
authors: Pau
authors: P
authors: Alonso
authors: Electrophysiology Section, Cardiology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain.
authors: Ydelise
authors: Y
authors: Rodríguez
authors: Electrophysiology Section, Cardiology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain.
authors: María-José
authors: MJ
authors: Sancho-Tello
authors: Electrophysiology Section, Cardiology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain.
authors: José
authors: J
authors: Olagüe
authors: Electrophysiology Section, Cardiology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain.
authors: José E
authors: JE
authors: Castro
authors: Electrophysiology Section, Cardiology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain.
authors: Antonio
authors: A
authors: Salvador
authors: Electrophysiology Section, Cardiology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain.
authors: Luis
authors: L
authors: Martínez-Dolz
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D017147:Defibrillators, Implantable / Q000009:adverse effects; D005260:Female; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D010138:Pacemaker, Artificial / Q000009:adverse effects; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants
keywords: anticoagulants; pacemakers; thromboembolic risk