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Analysis of Complications in Outpatient ICD Surgery On or Off Warfarin Anticoagulation

Aneesh Tolat1, Aniruddha Singh2, Melissa Woiciechowski2

  • 1Hoffman Heart and Vascular Institute, Saint Francis Hospital and Medical Center, University of Connecticut School of Medicine, Hartford., Connecticut. atolat@ctheartbeat.com.

Pacing and Clinical Electrophysiology : PACE
|August 18, 2016
PubMed

Insights

Outpatient implantable cardioverter defibrillator (ICD) surgery is safe for patients on warfarin anticoagulation, with comparable overall complication rates. However, warfarin increases the risk of pocket hematoma during ICD procedures.

Area of Science:

  • Cardiology
  • Medical Devices
  • Surgical Procedures

Background:

  • Implantable cardioverter defibrillator (ICD) implantation practices vary, with some centers performing same-day discharge and others overnight stays.
  • Many centers now perform ICD surgery on patients taking warfarin anticoagulation.
  • Limited data exists on the safety of outpatient ICD surgery for anticoagulated patients.

Purpose of the Study:

  • To evaluate the safety of outpatient ICD surgery in patients on warfarin anticoagulation compared to those not on anticoagulation.
  • To assess procedural and 30-day complication rates in both groups.

Main Methods:

  • A retrospective study of 866 patients undergoing outpatient ICD surgery from April 2010 to September 2014.
  • Patients on novel oral anticoagulants or without a recent INR were excluded.
  • Patients were divided into two groups: warfarin anticoagulated (n=230) and non-anticoagulated (n=518).

Main Results:

  • Overall 30-day complication rates were similar between the warfarin group (4.3%) and the non-anticoagulated group (2.9%), with no significant difference (P=0.31).
  • The pocket hematoma rate was significantly higher in the warfarin group (3.5%) compared to the non-anticoagulated group (0.4%) (P=0.001).

Conclusions:

  • Outpatient ICD surgery demonstrates low complication rates, whether patients are on or off warfarin anticoagulation.
  • Warfarin use during outpatient ICD surgery is associated with a higher incidence of pocket hematoma.
  • These findings support the safety of outpatient ICD procedures but highlight the increased risk of hematoma in patients on warfarin.
Abstract

Keywords:
ICDdefibrillatoroutpatientsurgerywarfarin

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