eISSN: 1897-4295
ISSN: 1734-9338
Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej
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SCImago Journal & Country Rank
2/2023
vol. 19
 
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abstract:
Review paper

Anticoagulant therapy during cardiovascular implantable electronic device procedures

Aurelija Daubaraitė
1
,
Germanas Marinskis
2
,
Gediminas Račkauskas
2

  1. Faculty of Medicine, Vilnius University, Vilnius, Lithuania
  2. Centre of Cardiology and Angiology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
Adv Interv Cardiol 2023; 19, 2 (72): 99–112
Online publish date: 2023/06/30
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Aim:
The objective of the study is to systematically evaluate the safety and efficacy of peri-procedural utilization of anticoagulation therapy during cardiovascular implantable electronic device procedures.

Material and methods:
The review materials were based on comprehensive retrieval of randomized controlled trials and observational studies published until April 2023. Studies which compared different management strategies of long-term anticoagulation therapy during peri-procedural cardiac rhythm device implantation and compared the complications of bleeding and/or thromboembolic events were selected and reviewed.

Results:
Studies analysing non-vitamin K oral anticoagulants interruption versus continuation during peri-procedural implantable cardiac device surgery found no statistically significant difference in bleeding or thromboembolic complications between these strategies. Studies comparing non-vitamin K oral anticoagulants with vitamin K antagonists also showed no statistically significant difference. One study comparing uninterrupted warfarin with interrupted warfarin with heparin bridging reported a reduced incidence of clinically significant device pocket haematoma in patients with continued warfarin treatment (relative risk = 0.19; 95% confidence interval: 0.10 to 0.36; p < 0.001). A sub-analysis of one study comparing dabigatran versus warfarin with heparin bridging and without bridging reported a lower risk of pocket haematoma with dabigatran when compared to warfarin with heparin bridging (risk difference: –8.62%, 95% confidence interval: –24.15 to –0.51%; p = 0.034). Both bleeding and thromboembolic complications were rare.

Conclusions:
The traditional method of vitamin K antagonists interruption with heparin bridging is less safe than continuing vitamin K antagonists at therapeutic levels. Both continuation and interruption strategies of non-vitamin K anticoagulants during cardiac device surgery seem to be safe and appropriate.

keywords:

cardiac resynchronization therapy, pacemaker, implantable cardioverter-defibrillator, anticoagulation, device pocket haematoma

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