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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
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Warfarin continuation vs interruption during procedures of cardiac rhythm devices: A Meta-analysis of randomized

Huan Sun1, Beibei Du1, Xueyan Liu2

  • 1Department of Cardiology, China-Japan Union Hospital of Jilin University, Changchun, China.

JPMA. the Journal of the Pakistan Medical Association
|April 29, 2016
PubMed

Insights

Continuing warfarin perioperatively during cardiac rhythm device implantation is safe and effective. Interruption with heparin bridging increases bleeding risk without affecting ischemic events in patients on chronic warfarin therapy.

Area of Science:

  • Cardiology
  • Pharmacology
  • Medical Devices

Background:

  • Patients on chronic anticoagulation require careful management during cardiac rhythm device (CRD) implantation.
  • Warfarin and heparin bridging are common strategies for managing anticoagulation perioperatively.
  • Uncertainty exists regarding the comparative safety and efficacy of these strategies.

Purpose of the Study:

  • To compare the safety and efficacy of continuing warfarin versus heparin-bridging therapy during CRD implantation.
  • To evaluate perioperative bleeding and ischemic risks associated with each anticoagulation strategy.

Main Methods:

  • A meta-analysis of four randomized controlled trials (RCTs) involving 941 patients.
  • Included studies focused on patients chronically treated with anticoagulants undergoing CRD implantation.

Main Results:

  • Continuing warfarin perioperatively resulted in significantly lower bleeding risk compared to heparin bridging (RD -0.08, 95% CI -0.17 to 0.02, p<0.05).
  • No significant difference in ischemic risk was observed between the two methods (RD 0, 95% CI -0.01 to 0.02, p=1.00).

Conclusions:

  • Continuation of warfarin treatment is a safe and effective perioperative strategy for CRD implantation in patients on long-term warfarin therapy.
  • Interruption of warfarin with heparin bridging may increase perioperative bleeding risk in this patient population.

Keywords:
Warfarin, Pacemaker, Artificial, Perioperative period.

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