Document Detail


Evaluation of a new standardized protocol for the perioperative management of chronically anticoagulated patients receiving implantable cardiac arrhythmia devices.
MedLine Citation:
PMID:  22001709     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: Perioperative management of oral anticoagulation (OAC) in patients receiving pacemakers or implantable cardioverter defibrillators (PM/ICDs) remains an issue of concern. OBJECTIVE: We sought to evaluate the safety and the effect on hospital length-of-stay of a new standardized protocol for perioperative management of OAC in this setting. METHODS: The new standardized protocol classified patients according to a renewed evaluation of their thromboembolic (TE) risk. Briefely, patients were considered at moderate-high TE risk if they had a mechanical valvular prostheses irrespective of type and location or atrial fibrillation associated with CHADS(2)≥2, mitral stenosis or previous stroke, and underwent device implantation without stopping OAC (OAC continued, n=129). Complete interruption of OAC before surgery was performed in low TE risk patients (OAC interrupted, n=82). A retrospective cohort of patients managed with a classic heparin-bridging strategy served as a control group, with 62 patients considered at moderate-high TE risk according to previous guidelines (receiving pre- and postoperative low-molecular-weight-heparin LMWH), and 146 considered at low TE risk (receiving only low doses of postoperative LMWH). RESULTS: TE events were comparable between the two strategies. Patients entering the new standardized protocol had significantly lower rates of pocket hematoma (2.3% for OAC contiued vs. 17.7% for moderate-high TE risk bridging controls, p=0.0001; and 0% for OAC interrupted vs. 13% for low TE risk bridging controls, p<0.0001) and shorter hospital stays. A mean of 3.34 hospitalization days per patient were saved with the new standardized protocol, with an estimated cost savings of 850.83€ per patient. CONCLUSIONS: Implantation of the new standardized protocol resulted in a significant reduction of bleeding complications and hospital stays, with adequate protection against TE events and significant cost savings.
Authors:
Oscar Cano; Begoña Muñoz; David Tejada; Joaquín Osca; María-José Sancho-Tello; José Olagüe; José E Castro; Antonio Salvador
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-10-11
Journal Detail:
Title:  Heart rhythm : the official journal of the Heart Rhythm Society     Volume:  -     ISSN:  1556-3871     ISO Abbreviation:  -     Publication Date:  2011 Oct 
Date Detail:
Created Date:  2011-10-17     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101200317     Medline TA:  Heart Rhythm     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2011. Published by Elsevier Inc.
Affiliation:
Electrophysiology Section, Cardiology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain; Instituto Investigación Sanitaria La Fe, Valencia, Spain.
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