Warfarin continuation vs interruption during procedures of cardiac rhythm devices: A Meta-analysis of randomized controlled trials.
To compare the safetyand efficacy of warfarin treatment continuation and heparin-bridging therapy during cardiac rhythm device (CRD) implantation in patients chronically treated with anticoagulants.We performed a search and analysis of peer-reviewed studies Four randomized controlled trials (RCTs)were included in our analysis with 941 patients. The bleeding risk in patients continuing warfarin perioperatively was lower than those interrupting warfarin and using a heparin-bridge (RD -0.08, 95% CI -0.17 to 0.02, p< 0.05). There was no significant difference in ischaemic risk between two methods (RD 0, 95% CI -0.01 to 0.02, p=1.00). Hence, in patients undergoing long-term warfarin therapy, continuation of warfarin treatment is a safe and efficacious perioperative strategy for during CRD implantations, while interruption of warfarin with a heparin bridge may increase the bleeding risk in these patients.
Department of Cardiology, China-Japan Union Hospital of Jilin University, Changchun, China.
Huan
H
Sun
Department of Cardiology, China-Japan Union Hospital of Jilin University, Changchun, China.
Beibei
B
Du
Liaquat National Hospital, Institute for Postgraduate Medical Studies and Health Science, Karachi, Pakistan.
Xueyan
X
Liu
Department of Cardiology, China-Japan Union Hospital of Jilin University, Changchun, China.
Sibao
S
Yang
Liaquat National Hospital, Institute for Postgraduate Medical Studies and Health Science, Karachi, Pakistan.
Ping
P
Yang
D000925:Anticoagulants / Q000627:therapeutic use*; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data*; D006406:Hematoma / Q000453:epidemiology*; D006493:Heparin / Q000627:therapeutic use*; D006801:Humans; D010138:Pacemaker, Artificial; D019990:Perioperative Care / Q000379:methods*; D019106:Postoperative Hemorrhage / Q000453:epidemiology*; D019919:Prosthesis Implantation / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D014859:Warfarin / Q000627:therapeutic use*
D000925:Anticoagulants; D014859:Warfarin; D006493:Heparin
Warfarin, Pacemaker, Artificial, Perioperative period.