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Perioperative management of oral anticoagulation in patients undergoing implantation of subcutaneous implantable cardioverter-defibrillator.
- Source :
-
Heart rhythm [Heart Rhythm] 2018 Apr; Vol. 15 (4), pp. 520-523. Date of Electronic Publication: 2017 Nov 13. - Publication Year :
- 2018
-
Abstract
- Background: The perioperative anticoagulation management during subcutaneous implantable cardioverter-defibrillator (S-ICD) implantation is still evolving.<br />Objective: The purpose of this study was to assess whether it is safe to perform S-ICD implantation with uninterrupted warfarin.<br />Methods: This is a single-center retrospective review of patients undergoing S-ICD implantation between October 1, 2012 and June 30, 2017. One hundred thirty-seven patients underwent successful S-ICD implantation during the study period. The most common indication for implantation was primary prevention of sudden cardiac death. In 24 (17.5%) patients, warfarin was continued without any interruption (warfarin group). In 113 (82.5%) patients, no warfarin was used in the perioperative period (nonwarfarin group). The incidence of clinically significant lateral pocket hematoma was compared in the 2 groups.<br />Results: The mean international normalized ratio was 1.83 ± 0.47 in the warfarin group and 1.09 ± 0.18 in the nonwarfarin group. A total of 8 patients developed a hematoma at the lateral pocket. No patient developed a hematoma at the parasternal pockets. Six patients (25%) in the warfarin group and 2 (1.5%) in the nonwarfarin group developed a significant lateral pocket hematoma (P = .001). The mean length of stay was longer in the warfarin group (1.23 ± 0.46 days) than in the nonwarfarin group (1.02 ± 0.18 days) (P = .0008). An international normalized ratio of >1.8 predicted the risk of hematoma. The concomitant use of dual antiplatelet therapy did not increase the risk of hematoma. None of the patients with a hematoma developed infection or required hematoma evacuation.<br />Conclusion: Uninterrupted warfarin in the perioperative period during S-ICD implantation is associated with an increased risk of significant lateral pocket hematoma that results in prolonged hospital stay.<br /> (Copyright © 2017 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Administration, Oral
Anticoagulants administration & dosage
Female
Follow-Up Studies
Humans
Male
Middle Aged
Retrospective Studies
Death, Sudden, Cardiac prevention & control
Defibrillators, Implantable
Perioperative Care methods
Primary Prevention methods
Prosthesis Implantation methods
Warfarin administration & dosage
Subjects
Details
- Language :
- English
- ISSN :
- 1556-3871
- Volume :
- 15
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- Heart rhythm
- Publication Type :
- Academic Journal
- Accession number :
- 29146276
- Full Text :
- https://doi.org/10.1016/j.hrthm.2017.11.010