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The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
Bridge or continue Coumadin for device surgery: a randomized controlled trial rationale and design
David Birnie1, Jeffrey S Healey, Andrew Krahn
1University of Ottawa Heart Institute, Ottawa, Canada. dbirnie@ottawaheart.ca
Current Opinion in Cardiology
|December 24, 2008
Summary
Managing anticoagulation for cardiac device surgery is challenging. Continuing oral anticoagulation, instead of bridging, may reduce hematoma risk without increasing thromboembolic events.
Area of Science:
- Cardiology
- Electrophysiology
- Anticoagulation Management
Background:
- Patients needing cardiac device surgery often take oral anticoagulation.
- Periprocedural anticoagulation management poses a dilemma, especially for high thromboembolic risk patients.
- Bridging anticoagulation increases hematoma risk, thromboembolic events, and costs.
Purpose of the Study:
- To evaluate the safety and efficacy of continuing oral anticoagulation versus bridging during cardiac device surgery.
- To determine the optimal anticoagulation strategy for patients undergoing cardiac device implantation.
Main Methods:
- Prospective, single-blind, randomized controlled trial.
- Conventional arm: bridging anticoagulation.
- Experimental arm: continued oral anticoagulation.
- Primary outcome: clinically significant hematoma.
Main Results:
- Observational data suggest reduced hematoma rates with continued oral anticoagulation.
- Randomized trial data are needed to confirm safety and efficacy.
- The study addresses a clinical question relevant to approximately 70,000 North American patients annually.
Conclusions:
- A randomized trial is designed to compare bridging versus continued oral anticoagulation for cardiac device surgery.
- The study aims to provide evidence-based guidance for managing anticoagulation in this patient population.
