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Updated: Jul 23, 2025
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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
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Anticoagulant therapy during cardiovascular implantable electronic device procedures
Aurelija Daubaraitė1, Germanas Marinskis2, Gediminas Račkauskas2
1Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
Summary
Continuing anticoagulation therapy during cardiac device procedures is safer than interruption with heparin bridging. Both non-vitamin K oral anticoagulants continuation and interruption strategies appear safe for patients undergoing cardiac rhythm device implantation.
Area of Science:
- Cardiology
- Pharmacology
- Medical Devices
Background:
- Anticoagulation therapy is crucial for preventing thromboembolic events but poses bleeding risks during procedures.
- Managing anticoagulation peri-procedurally for cardiovascular implantable electronic device (CIED) implantation requires careful consideration of safety and efficacy.
Purpose of the Study:
- To systematically evaluate the safety and efficacy of peri-procedural anticoagulation strategies for CIED procedures.
- To compare different management approaches for anticoagulation therapy during cardiac rhythm device implantation.
Main Methods:
- A comprehensive review of randomized controlled trials and observational studies published up to April 2023.
- Selection of studies comparing anticoagulation management strategies and their associated bleeding or thromboembolic complications.
Main Results:
- No significant difference in bleeding or thromboembolic complications between non-vitamin K oral anticoagulants (NOACs) interruption and continuation.
- Continuing warfarin was associated with a significantly lower risk of device pocket hematoma compared to interrupted warfarin with heparin bridging.
- Dabigatran showed a lower risk of pocket hematoma compared to warfarin with heparin bridging.
Conclusions:
- Continuing vitamin K antagonists (VKAs) at therapeutic levels is safer than interruption with heparin bridging.
- Both continuation and interruption strategies for NOACs during cardiac device surgery are safe and appropriate.
- Bleeding and thromboembolic complications associated with peri-procedural anticoagulation for CIEDs are generally rare.
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