title: Safety of anticoagulation with uninterrupted warfarin vs. interrupted dabigatran in patients requiring an implantable cardiac device.
abstract: BACKGROUND
  The optimal strategy of peri-procedural anticoagulation in patients undergoing permanent cardiac device implantation is controversial. Our objective was to compare the major bleeding and thromboembolic complications in patients managed with uninterrupted warfarin (UW) vs. interrupted dabigatran (ID) during permanent pacemaker (PPM) or implantable cardioverter defibrillators (ICD) implantation.
  
  
  METHODS
  A retrospective cohort study of all eligible patients from July 2011 through January 2012 was performed. UW was defined as patients who had maintained a therapeutic international normalized ratio (INR) on the day of the procedure. ID was defined as stopping dabigatran ≥12 hours prior to the procedure and then resuming after implantation. Major bleeding events included hemothorax, hemopericardium, intracranial hemorrhage, gastrointestinal bleed, epistaxis, or pocket hematoma requiring surgical intervention. Thromboembolic complications included stroke, transient ischemic attack, deep venous thrombosis, pulmonary embolism, or arterial embolism.
  
  
  RESULTS
  Of the 133 patients (73.4±11.0 years; 91 males) in the study, 86 received UW and 47 received ID. One (1.2%) patient in the UW group sustained hemopericardium perioperatively and died. In comparison, the ID patients had no complications. As compared to the ID group, the UW group had a higher median CHADS2 score (2 vs. 3, P=0.04) and incidence of Grade 1 pocket hematoma (0% vs. 7%, P=0.09). Neither group developed any thromboembolic complications.
  
  
  CONCLUSIONS
  Major bleeding rates were similar among UW and ID groups. Perioperative ID appears to be a safe anticoagulation strategy for patients undergoing PPM or ICD implantation.
authors.affiliation: 1 University of North Carolina Hospitals, Chapel Hill, NC, USA ; 2 St. Vincent Hospital, University of Massachusetts Medical School, Worcester, MA, USA ; 3 St. Louis Children's Hospital, Washington University, St. Louis, MO, USA ; 4 Spectrum Health, Department of Cardiovascular Services, Frederik Meijer Heart & Vascular Institute, Grand Rapids, MI, USA ; 5 Department of Research, Grand Rapids Medical Education Partners, Grand Rapids, MI, USA ; 6 Department of Surgery, Michigan State University, USA.
authors.forename: Shivanshu
authors.initials: S
authors.lastname: Madan
authors.affiliation: 1 University of North Carolina Hospitals, Chapel Hill, NC, USA ; 2 St. Vincent Hospital, University of Massachusetts Medical School, Worcester, MA, USA ; 3 St. Louis Children's Hospital, Washington University, St. Louis, MO, USA ; 4 Spectrum Health, Department of Cardiovascular Services, Frederik Meijer Heart & Vascular Institute, Grand Rapids, MI, USA ; 5 Department of Research, Grand Rapids Medical Education Partners, Grand Rapids, MI, USA ; 6 Department of Surgery, Michigan State University, USA.
authors.forename: Purushothaman
authors.initials: P
authors.lastname: Muthusamy
authors.affiliation: 1 University of North Carolina Hospitals, Chapel Hill, NC, USA ; 2 St. Vincent Hospital, University of Massachusetts Medical School, Worcester, MA, USA ; 3 St. Louis Children's Hospital, Washington University, St. Louis, MO, USA ; 4 Spectrum Health, Department of Cardiovascular Services, Frederik Meijer Heart & Vascular Institute, Grand Rapids, MI, USA ; 5 Department of Research, Grand Rapids Medical Education Partners, Grand Rapids, MI, USA ; 6 Department of Surgery, Michigan State University, USA.
authors.forename: Katie L
authors.initials: KL
authors.lastname: Mowers
authors.affiliation: 1 University of North Carolina Hospitals, Chapel Hill, NC, USA ; 2 St. Vincent Hospital, University of Massachusetts Medical School, Worcester, MA, USA ; 3 St. Louis Children's Hospital, Washington University, St. Louis, MO, USA ; 4 Spectrum Health, Department of Cardiovascular Services, Frederik Meijer Heart & Vascular Institute, Grand Rapids, MI, USA ; 5 Department of Research, Grand Rapids Medical Education Partners, Grand Rapids, MI, USA ; 6 Department of Surgery, Michigan State University, USA.
authors.forename: Darryl A
authors.initials: DA
authors.lastname: Elmouchi
authors.affiliation: 1 University of North Carolina Hospitals, Chapel Hill, NC, USA ; 2 St. Vincent Hospital, University of Massachusetts Medical School, Worcester, MA, USA ; 3 St. Louis Children's Hospital, Washington University, St. Louis, MO, USA ; 4 Spectrum Health, Department of Cardiovascular Services, Frederik Meijer Heart & Vascular Institute, Grand Rapids, MI, USA ; 5 Department of Research, Grand Rapids Medical Education Partners, Grand Rapids, MI, USA ; 6 Department of Surgery, Michigan State University, USA.
authors.forename: Bohuslav
authors.initials: B
authors.lastname: Finta
authors.affiliation: 1 University of North Carolina Hospitals, Chapel Hill, NC, USA ; 2 St. Vincent Hospital, University of Massachusetts Medical School, Worcester, MA, USA ; 3 St. Louis Children's Hospital, Washington University, St. Louis, MO, USA ; 4 Spectrum Health, Department of Cardiovascular Services, Frederik Meijer Heart & Vascular Institute, Grand Rapids, MI, USA ; 5 Department of Research, Grand Rapids Medical Education Partners, Grand Rapids, MI, USA ; 6 Department of Surgery, Michigan State University, USA.
authors.forename: Andre J
authors.initials: AJ
authors.lastname: Gauri
authors.affiliation: 1 University of North Carolina Hospitals, Chapel Hill, NC, USA ; 2 St. Vincent Hospital, University of Massachusetts Medical School, Worcester, MA, USA ; 3 St. Louis Children's Hospital, Washington University, St. Louis, MO, USA ; 4 Spectrum Health, Department of Cardiovascular Services, Frederik Meijer Heart & Vascular Institute, Grand Rapids, MI, USA ; 5 Department of Research, Grand Rapids Medical Education Partners, Grand Rapids, MI, USA ; 6 Department of Surgery, Michigan State University, USA.
authors.forename: Alan K
authors.initials: AK
authors.lastname: Woelfel
authors.affiliation: 1 University of North Carolina Hospitals, Chapel Hill, NC, USA ; 2 St. Vincent Hospital, University of Massachusetts Medical School, Worcester, MA, USA ; 3 St. Louis Children's Hospital, Washington University, St. Louis, MO, USA ; 4 Spectrum Health, Department of Cardiovascular Services, Frederik Meijer Heart & Vascular Institute, Grand Rapids, MI, USA ; 5 Department of Research, Grand Rapids Medical Education Partners, Grand Rapids, MI, USA ; 6 Department of Surgery, Michigan State University, USA.
authors.forename: Timothy D
authors.initials: TD
authors.lastname: Fritz
authors.affiliation: 1 University of North Carolina Hospitals, Chapel Hill, NC, USA ; 2 St. Vincent Hospital, University of Massachusetts Medical School, Worcester, MA, USA ; 3 St. Louis Children's Hospital, Washington University, St. Louis, MO, USA ; 4 Spectrum Health, Department of Cardiovascular Services, Frederik Meijer Heart & Vascular Institute, Grand Rapids, MI, USA ; 5 Department of Research, Grand Rapids Medical Education Partners, Grand Rapids, MI, USA ; 6 Department of Surgery, Michigan State University, USA.
authors.forename: Alan T
authors.initials: AT
authors.lastname: Davis
authors.affiliation: 1 University of North Carolina Hospitals, Chapel Hill, NC, USA ; 2 St. Vincent Hospital, University of Massachusetts Medical School, Worcester, MA, USA ; 3 St. Louis Children's Hospital, Washington University, St. Louis, MO, USA ; 4 Spectrum Health, Department of Cardiovascular Services, Frederik Meijer Heart & Vascular Institute, Grand Rapids, MI, USA ; 5 Department of Research, Grand Rapids Medical Education Partners, Grand Rapids, MI, USA ; 6 Department of Surgery, Michigan State University, USA.
authors.forename: Nagib T
authors.initials: NT
authors.lastname: Chalfoun
keywords: Dabigatran; defibrillator; pacemaker; perioperative anticoagulation; warfarin