| Meta-analysis of bleeding complications associated with cardiac rhythm device implantation. | |
| | |
MedLine Citation:
|
PMID: 22534249 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
BACKGROUND: Many patients receiving cardiac rhythm devices have conditions requiring antiplatelet (AP) and/or anticoagulant (AC) therapy. Current guidelines recommend a heparin-bridging strategy (HBS) for anticoagulated patients with moderate/high risk for thrombosis. Several studies reported lower bleeding risk with continued oral anticoagulation rather than HBS. The best strategy for perioperative management of patients on AP therapy is less clear. The present study was designed as a meta-analysis of device implantation-associated bleeding complications using different AC/AP therapies. METHODS AND RESULTS: PubMed and Cochrane Database searches identified articles based on design, outcomes, and available data. Device recipients were grouped as follows: no therapy, aspirin only, AC held, AC continued, dual AP, and HBS. The primary outcome was defined as a bleeding complication including hematoma, transfusion, or prolonged hospital stay. Thirteen articles were identified for analysis including 5978 patients. The combined incidence of bleeding complications was 274 of 5978 (4.6%), ranging from 2.2% (no therapy) to 14.6% (HBS). The estimated odds of bleeding were increased by 8.3 (95% CI, 5.5-12.9) times in the HBS group, 5.0 (95% CI, 3.0-8.3) for dual AP therapy, 1.7 (95% CI, 1.0-3.1) for AC held, 1.6 (95% CI, 0.9-2.6) for AC continued, and 1.5 (95% CI, 0.9-2.3) for aspirin only relative to the no therapy group. HBS significantly increased bleeding events compared with holding or continuing AC. Continuing AC did not increase bleeding events compared with no therapy. CONCLUSIONS: Continuing AC appears safer than HBS for device implantation. Dual AP therapy but not continuing AC carries a significant risk of bleeding. |
| | |
Authors:
|
Michael L Bernard; Matthew Shotwell; Paul J Nietert; Michael R Gold |
Related Documents
:
|
7794619 - Upper and lower gastrointestinal complications with dexamethasone despite h2 antagonists. 18177449 - Adverse events associated with the use of cyclosporine in patients with inflammatory bo... 2523099 - A prospective comparison of murine monoclonal cd-3 (okt3) antibody-based and equine ant... 23314919 - Predictive risk factors of cardiorespiratory abnormality for upper gastrointestinal end... 11875609 - The value of switching from cyclosporine to tacrolimus in the treatment of refractory a... 16618399 - Infliximab plus azathioprine for steroid-dependent crohn's disease patients: a randomiz... 6374679 - Nabumetone: a double-blind study in osteoarthrosis. 20350159 - Xenogeneic collagen matrix with coronally advanced flap compared to connective tissue w... 21723089 - Total knee arthroplasty in patients with stiff knees. |
Publication Detail:
|
Type: Journal Article; Meta-Analysis; Research Support, N.I.H., Extramural; Review Date: 2012-04-24 |
Journal Detail:
|
Title: Circulation. Arrhythmia and electrophysiology Volume: 5 ISSN: 1941-3084 ISO Abbreviation: Circ Arrhythm Electrophysiol Publication Date: 2012 Jun |
Date Detail:
|
Created Date: 2012-06-20 Completed Date: 2012-09-04 Revised Date: 2013-06-06 |
Medline Journal Info:
|
Nlm Unique ID: 101474365 Medline TA: Circ Arrhythm Electrophysiol Country: United States |
Other Details:
|
Languages: eng Pagination: 468-74 Citation Subset: IM |
Affiliation:
|
Division of Cardiology, Medical University of South Carolina, Charleston, SC 29425, USA. |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Anticoagulants
/
administration & dosage,
adverse effects* Arrhythmias, Cardiac / therapy* Defibrillators, Implantable* Hemorrhage / chemically induced*, epidemiology Humans Pacemaker, Artificial* Practice Guidelines as Topic Prevalence Risk Factors Thrombosis / prevention & control |
| Grant Support | |
ID/Acronym/Agency:
|
UL1 RR029882/RR/NCRR NIH HHS; UL1RR029882/RR/NCRR NIH HHS |
| Chemical | |
Reg. No./Substance:
|
0/Anticoagulants |
| Comments/Corrections | |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: In Vitro Kinetic Evaluation of the Free Radical Scavenging Ability of Propofol.
Next Document: Early repolarization is an independent predictor of occurrences of ventricular fibrillation in the v...