| No Increased Bleeding Events with Continuation of Oral Anticoagulation Therapy for Patients Undergoing Cardiac Device Procedure. | |
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MedLine Citation:
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PMID: 21410724 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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Background: Switching warfarin for heparin has been a practice for managing periprocedural anticoagulation in high-risk patients undergoing device-related procedures. We sought to investigate whether continuation of warfarin sodium therapy without heparin bridging is safe and, when it is continued, the optimal international normalized ratio (INR) without increased bleeding risk at time of device-related procedure. Methods and Results: We retrospectively studied 766 consecutive patients taking warfarin long term who underwent device-related procedures. Patients were grouped by treatment: discontinued warfarin (-warfarin, n = 243), no interruption of warfarin (+warfarin, n = 324), and discontinued warfarin with heparin bridging (+heparin, n = 199). The study primary endpoint was systemic bleeding or formation of moderate or severe pocket hematoma within 30 days of the procedure. Thirty-one (4%) patients had bleeding events, including pocket hematoma in 29 patients. The bleeding events occurred more often for +heparin (7.0%) than -warfarin (2.1%) or +warfarin (3.7%, P = 0.029). For +warfarin group, INR of 2.0-2.5 at time of procedure did not increase bleeding risk compared with INR less than 1.5 (3.7% vs 3.4%; P = 0.72), but INR greater than 2.5 increased the bleeding risk (10.0% vs 3.4%; P = 0.029). Concomitant aspirin use with warfarin significantly increased bleeding risk than warfarin alone (5.6% vs 1.4%, P = 0.02). Median length of hospitalization was significantly shorter for +warfarin than +heparin (1 vs 6 days; P < 0.001). Conclusion: Continuation of oral anticoagulation therapy with an INR level of <2.5 does not impose increased risk of bleeding for device-related procedures, although precaution is necessary to avoid supratherapeutic anticoagulation levels. (PACE 2011; 1-7). |
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Authors:
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Hung-Kei Li; Frank C Chen; Robert F Rea; Samuel J Asirvatham; Brian D Powell; Paul A Friedman; Win-Kuang Shen; Peter A Brady; David J Bradley; Hon-Chi Lee; David O Hodge; Joshua P Slusser; David L Hayes; Yong-Mei Cha |
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Publication Detail:
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Type: JOURNAL ARTICLE Date: 2011-3-16 |
Journal Detail:
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Title: Pacing and clinical electrophysiology : PACE Volume: - ISSN: 1540-8159 ISO Abbreviation: - Publication Date: 2011 Mar |
Date Detail:
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Created Date: 2011-3-17 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 7803944 Medline TA: Pacing Clin Electrophysiol Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Copyright Information:
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©2011, The Authors. Journal compilation ©2011 Wiley Periodicals, Inc. |
Affiliation:
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Division of Cardiovascular Diseases Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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