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The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation

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Published on: February 28, 2012

Anticoagulation bridging around device surgery: compliance with guidelines.

Mark J Perrin¹, Brian Z Vezi, Andrew C Ha

¹Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Canada.

Pacing and Clinical Electrophysiology : PACE

|September 18, 2012

Summary

Bridging anticoagulation is underused postoperatively for high-risk patients and overused for low-risk patients undergoing cardiac device surgery, leading to complications. Adherence to guidelines is crucial for safe and effective patient care.

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The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation

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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation

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Published on: February 26, 2013

Area of Science:

Cardiology
Thrombosis Management
Medical Device Surgery

Background:

Current guidelines recommend bridging anticoagulation for moderate/high thromboembolic risk patients during cardiac rhythm device surgery.
Low-risk patients are advised to stop oral anticoagulation without bridging.
Real-world adherence to these guidelines and associated clinical outcomes require examination.

Purpose of the Study:

To assess adherence to current guidelines for bridging anticoagulation in patients undergoing cardiac rhythm device surgery.
To evaluate the clinical sequelae, including bleeding and thromboembolism, of nonadherence to these guidelines.

Main Methods:

A retrospective review of 129 patients on chronic anticoagulation undergoing device surgery was conducted.
Patients were risk-stratified into 'moderate/high' or 'low' risk groups for thromboembolism per American College of Chest Physicians guidelines.
Perioperative anticoagulation management was compared to guidelines, and rates of bleeding and thromboembolism were assessed.

Main Results:

Of 129 patients, 62 were moderate/high risk and 67 were low risk.
Bridging anticoagulation was underutilized postoperatively in 40% of moderate/high-risk patients.
Bridging was overused in 33% of low-risk patients, associated with bleeding complications (4/10 cases). No perioperative thromboembolisms occurred.

Conclusions:

Significant underutilization of postoperative bridging anticoagulation was observed in moderate/high-risk patients.
Overuse of bridging in low-risk patients was linked to bleeding complications.
Physicians must adhere to expert guidelines for bridging anticoagulation in cardiac rhythm device surgery.