title: Analysis of Complications in Outpatient ICD Surgery On or Off Warfarin Anticoagulation.
abstract: BACKGROUND
  Implantable cardioverter defibrillator (ICD) implantation is being performed differently at many hospitals, with some keeping patients overnight after procedure while others discharge patients home same day. In addition, many centers are now performing ICD surgery while on warfarin anticoagulation. There are, however, limited data on outpatient ICD surgery on anticoagulated (AC) patients.
  
  
  OBJECTIVE
  We wished to evaluate the safety of performing outpatient ICD surgery with and without warfarin anticoagulation.
  
  
  METHODS
  We evaluated 866 patients who underwent outpatient ICD surgery between April 2010 and September 2014. Patients who were on novel oral anticoagulants, or did not have an international normalized ratio drawn within 24 hours of the procedure were excluded and the remainder were divided into two groups based on whether they were on (n = 230) or off (n = 518) warfarin anticoagulation. We evaluated both procedural and 30-day complications in both groups.
  
  
  RESULTS
  The complication rate at 30 days in the warfarin AC group was 4.3%, while in the nonanticoagulated (NAC) group was 2.9% and not significantly different (P = 0.31). However, the pocket hematoma rate in the warfarin anticoagulated group was 3.5%, as compared to the NAC group that was 0.4% (P = 0.001).
  
  
  CONCLUSIONS
  Complications from ICD surgery are low in the ambulatory setting on or off warfarin anticoagulation and appear to be comparable. However, warfarin use during ICD surgery is associated with an increased risk of pocket hematoma.
authors.affiliation: Hoffman Heart and Vascular Institute, Saint Francis Hospital and Medical Center, University of Connecticut School of Medicine, Hartford., Connecticut. atolat@ctheartbeat.com.
authors.forename: Aneesh
authors.initials: A
authors.lastname: Tolat
authors.affiliation: Hoffman Heart and Vascular Institute, Saint Francis Hospital and Medical Center, University of Connecticut School of Medicine, Hartford., Connecticut.
authors.forename: Aniruddha
authors.initials: A
authors.lastname: Singh
authors.affiliation: Hoffman Heart and Vascular Institute, Saint Francis Hospital and Medical Center, University of Connecticut School of Medicine, Hartford., Connecticut.
authors.forename: Melissa
authors.initials: M
authors.lastname: Woiciechowski
authors.affiliation: Hoffman Heart and Vascular Institute, Saint Francis Hospital and Medical Center, University of Connecticut School of Medicine, Hartford., Connecticut.
authors.forename: Maura
authors.initials: M
authors.lastname: Masotti
authors.affiliation: Hoffman Heart and Vascular Institute, Saint Francis Hospital and Medical Center, University of Connecticut School of Medicine, Hartford., Connecticut.
authors.forename: Joseph
authors.initials: J
authors.lastname: Dell'orfano
authors.affiliation: Hoffman Heart and Vascular Institute, Saint Francis Hospital and Medical Center, University of Connecticut School of Medicine, Hartford., Connecticut.
authors.forename: Ellison
authors.initials: E
authors.lastname: Berns
authors.affiliation: St. Christopher's Hospital for Children, Philadelphia, Pennsylvania.
authors.forename: Bruce
authors.initials: B
authors.lastname: Bernstein
authors.affiliation: Hoffman Heart and Vascular Institute, Saint Francis Hospital and Medical Center, University of Connecticut School of Medicine, Hartford., Connecticut.
authors.forename: Neal
authors.initials: N
authors.lastname: Lippman
mesh_terms: D000368:Aged; D000553:Ambulatory Care; D000925:Anticoagulants / Q000009:adverse effects*; D017147:Defibrillators, Implantable / Q000009:adverse effects*; D005260:Female; D006406:Hematoma / Q000139:chemically induced; D006801:Humans; D008297:Male; D011183:Postoperative Complications; D019919:Prosthesis Implantation / Q000009:adverse effects; D012449:Safety; D014859:Warfarin / Q000009:adverse effects*
chemical_list: D000925:Anticoagulants; D014859:Warfarin
keywords: ICD; defibrillator; outpatient; surgery; warfarin