1. Evaluation of a new standardized protocol for the perioperative management of chronically anticoagulated patients receiving implantable cardiac arrhythmia devices.
- Author
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Cano O, Muñoz B, Tejada D, Osca J, Sancho-Tello MJ, Olagüe J, Castro JE, and Salvador A
- Subjects
- Administration, Oral, Aged, Aged, 80 and over, Clinical Protocols standards, Cost Savings, Defibrillators, Implantable, Drug Substitution methods, Drug Substitution standards, Female, Heparin, Low-Molecular-Weight administration & dosage, Humans, International Normalized Ratio, Length of Stay, Male, Middle Aged, Monitoring, Physiologic methods, Multivariate Analysis, Pacemaker, Artificial, Patient Selection, Risk Factors, Anticoagulants administration & dosage, Anticoagulants adverse effects, Cardiac Pacing, Artificial economics, Cardiac Pacing, Artificial methods, Cardiac Pacing, Artificial standards, Perioperative Care methods, Perioperative Care standards, Perioperative Care statistics & numerical data, Postoperative Hemorrhage epidemiology, Postoperative Hemorrhage etiology, Postoperative Hemorrhage prevention & control, Thromboembolism epidemiology, Thromboembolism etiology, Thromboembolism prevention & control
- Abstract
Background: Perioperative management of oral anticoagulation (OAC) in patients receiving pacemakers or implantable cardioverter-defibrillators remains an issue of concern., Objective: We sought to evaluate the safety and the effect on the 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. Briefly, patients were considered at moderate-to-high TE risk if they had a mechanical valvular prostheses irrespective of type and location or atrial fibrillation associated with a CHADS(2)score of ≥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-to-high TE risk according to previous guidelines (receiving pre- and postoperative low-molecular-weight heparin) and 146 considered at low TE risk (receiving only low doses of postoperative low-molecular-weight heparin)., Results: TE events were comparable between the 2 strategies. Patients entering the new standardized protocol had significantly lower rates of pocket hematoma (2.3% for OAC continued vs 17.7% for moderate-to-high TE risk bridging controls, P = .0001, and 0% for OAC interrupted vs 13% for low-TE-risk bridging controls, P <.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 in bleeding complications and hospital stays, with adequate protection against TE events and significant cost savings., (Copyright © 2012 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.)
- Published
- 2012
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