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Pacemaker or defibrillator surgery without interruption of anticoagulation.

David H Birnie1, Jeff S Healey, George A Wells

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Continuing warfarin during pacemaker or implantable cardioverter-defibrillator (ICD) surgery significantly reduces device-pocket hematoma compared to heparin bridging. This approach is safer for patients at high risk of thromboembolic events.

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Area of Science:

  • Cardiology
  • Medical Devices
  • Pharmacology

Background:

  • Many patients needing pacemaker or implantable cardioverter-defibrillator (ICD) surgery are on warfarin.
  • Guidelines suggest heparin bridging for high thromboembolic risk, but evidence for continuing warfarin is limited.

Purpose of the Study:

  • To compare the safety and efficacy of continuing warfarin versus heparin bridging therapy in patients undergoing pacemaker or ICD surgery.

Main Methods:

  • Randomized trial comparing continued warfarin to heparin bridging in patients with ≥5% annual thromboembolic risk.
  • Primary outcome: clinically significant device-pocket hematoma.

Main Results:

  • Continued warfarin significantly reduced device-pocket hematoma (3.5% vs. 16.0%, P<0.001).
  • Major surgical and thromboembolic complications were rare and similar between groups.

Conclusions:

  • Continuing warfarin markedly reduces device-pocket hematoma compared to heparin bridging.
  • This strategy appears safer for patients undergoing cardiac device surgery.