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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
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Implanting cardiac rhythm devices during uninterrupted warfarin therapy: a prospective, single center experience

Martino Crosato1, Vittorio Calzolari, Enrico Franceschini Grisolia

  • 1aDivision of Cardiology, Ospedale Civile di Treviso 'Ca' Foncello', Treviso bDivision of Cardiology, Ospedale di Cesena 'Bufalini', Cesena, Italy.

Journal of Cardiovascular Medicine (Hagerstown, Md.)
|July 16, 2014
PubMed

Insights

Cardiac rhythm device implantation is safe without interrupting warfarin therapy. This study found no increased bleeding risk in patients on uninterrupted warfarin compared to those who stopped the medication before their procedure.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Device Implantation

Background:

  • Oral anticoagulant therapy, particularly warfarin, is crucial for patients with high thromboembolic risk.
  • Traditional practice often involves interrupting warfarin before cardiac rhythm device implantation, increasing stroke risk.
  • Assessing the safety of uninterrupted warfarin during these procedures is vital for patient management.

Purpose of the Study:

  • To evaluate the safety of implanting cardiac rhythm devices (pacemakers, defibrillators) while patients remain on uninterrupted warfarin.
  • To compare bleeding complication rates between patients undergoing device implantation on uninterrupted warfarin versus those who stopped warfarin.

Main Methods:

  • A comparative study involving 191 patients undergoing cardiac rhythm device implantation.
  • The 'on warfarin group' (n=102) had procedures during uninterrupted warfarin therapy.
  • The 'off warfarin group' (n=89) underwent procedures after warfarin withdrawal; this group included lower-risk patients for comparison.

Main Results:

  • No significant difference in hematoma incidence (5% vs. 3%, P=not significant) between the 'on warfarin' and 'off warfarin' groups.
  • All hematomas observed were minor and resolved spontaneously.
  • There were no instances of death, hemothorax, tamponade, or significant bleeding complications in either group; no thromboembolic events occurred within 2 months.

Conclusions:

  • Cardiac rhythm device implantation can be safely performed without interrupting warfarin therapy in high-risk patients.
  • Uninterrupted warfarin does not appear to increase the risk of significant bleeding complications compared to warfarin interruption.
  • This approach may help mitigate thromboembolic risks associated with discontinuing anticoagulation.
Abstract

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