'Heparin bridging' increases the risk of bleeding complications in patients undergoing anticoagulation therapy and device implantation

Background: The purpose of this study is to evaluate the rate of perioperative bleeding complications following anticoagulation therapy in patients undergoing implantable electronic device implantation. Methods and results: We retrospectively analyzed the data from 161 consecutive patients with new device implants or generator replacement performed between February 2008 and June 2009 in our hospital. Sixty-five (40.3%) patients took warfarin, 55 (34.2%) took antiplatelet therapy, and 16 (9.9%) took dual antiplatelet therapy prior to implantation. Heparin bridging was performed in 7 of 65 patients taking warfarin. Pocket hematoma was observed in 10 (6.2%) patients and device infection was observed in 1 (0.6%) patient. No cases of thromboembolism were observed. There were no complications associated with warfarin (P=0.19) or antiplatelet therapy (P=0.69). However, the patients that had undergone heparin bridging were significantly more likely to have complications (3 of 10) (P=0.005). In multivariate analysis, heparin bridging was the only independent predictor of complications. Conclusion: Our study suggests that heparin bridging increases the risk of perioperative bleeding complications in cardiac device implantation.