Document Detail

Perioperative bridging of chronic oral anticoagulation in patients undergoing pacemaker implantation-a study in 200 patients.
MedLine Citation:
PMID:  21508005     Owner:  NLM     Status:  Publisher    
Objective To assess the risk of bleeding and thromboembolism (TE) of bridging therapy with low molecular weight heparin (LMWH) in patients undergoing pacemaker implantation. Background Current guidelines on peri-procedural management of patients with chronic oral anticoagulation (OAC) give no explicit recommendations on how to treat patients undergoing pacemaker implantations. Methods and Results Since 2000 all patients with chronic OAC undergoing pacemaker implantation were prospectively enrolled and treated following a pre- specified bridging regimen with enoxaparin using reduced LMWH doses in patients at non high TE risk and renal impairment. Patients were followed up for 30 days regarding bleeding complications, incidence of thromboembolism, length of therapy and adverse events following bridging therapy. 200 patients (age 78.4 ± 8.3 years; 60.5% male) were enrolled and treated with enoxaparin for a mean of 7.3 ± 4.2 days. 109 patients (54.4%) were assigned to high TE risk and 91 (45.6%) to non high TE risk. Renal insufficiency (CrCl of <50 ml/min) was present in 92 patients (46%). After risk stratification 72.5% of patients (n = 145) were treated with reduced LMWH doses. Outpatient treatment was feasible in 39 patients (19.5%). Nine bleeding complications were observed (4.5%; 95% confidence interval [CI] 2.1-8.4%), including one major bleed (0.5%; 95% CI 0.01%-2.75%) and eight minor bleeds (4%; 95% CI 1.74%-7.73%). No thromboembolic complications evolved due to bridging therapy (0%; 95% CI 0.0-1.49%). After multivariate regression analysis independent predictors for bleedings were the development of thrombozytopenia (hazard ratio [HR] 6.0, 95% CI 0.3-139.8; P = 0.002), the prevalence of congestive heart failure (HR 4.5, 95% CI 0.9-22.2; P = 0.01), high TE risk (HR 6.9, 95% CI 1.9-25.6; P = 0.03) and an increasing CHADS(2) score (HR 2.3, 95% CI 1.0-5.4; P = 0.05). Conclusion Oral anticoagulation can be safely interrupted before pacemaker implantation under overlapping therapy with enoxaparin. Reducing heparin doses in patients with low thromboembolic risk and renal insufficiency led to a low incidence of major bleeding without increasing thromboembolic events.
Christoph Hammerstingl; Heyder Omran
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-4-19
Journal Detail:
Title:  Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology     Volume:  -     ISSN:  1532-2092     ISO Abbreviation:  -     Publication Date:  2011 Apr 
Date Detail:
Created Date:  2011-4-21     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100883649     Medline TA:  Europace     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
1Medizinische Klinik und Poliklinik II, Universitätsklinikum Bonn.
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