Perioperative anticoagulation in patients having implantation of a cardiac pacemaker or defibrillator: a systematic review and practical management guide.

نویسندگان

  • E Jamula
  • J D Douketis
  • S Schulman
چکیده

BACKGROUND The perioperative management of anticoagulation in patients who are having implantation of a pacemaker or implantable cardioverter defibrillator (ICD) is a common clinical problem in which best clinical practise is not established. METHODS We performed a systematic review of the literature to assess the safety (pocket hematoma risk) and efficacy (thromboembolism risk) of different management strategies. We included studies involving patients who were having pacemaker or ICD implantation whenever a portion of these patients were receiving a coumarin and also assessed pocket hematoma or thromboembolism. RESULTS We identified eight studies that assessed two strategies used for perioperative anticoagulation management: interruption of a coumarin and use of bridging anticoagulation with a short-acting heparin; and perioperative continuation of a coumarin. A strategy involving bridging anticoagulation with therapeutic-dose heparin was associated with an incidence of pocket hematoma of 12-20%. A strategy involving perioperative continuation of a coumarin was associated with an incidence of pocket bleeding of 1.9-6.6%. The incidence of thromboembolic events was 0-1%, irrespective of the perioperative anticoagulation strategy used. CONCLUSION The perioperative anticoagulation management of patients who require pacemaker or ICD implantation is not established but a strategy involving postoperative bridging with intravenous heparin confers a high risk for bleeding whereas perioperative continuation of a coumarin appears to confer a lower risk for bleeding.

برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

منابع مشابه

Remote Monitoring of Cardiac Implantable Electronic Devices

Pacemakers, implantable cardioverter-defibrillators, and cardiac resynchronization devices use advanced diagnostic functions to continuously monitor the patient and the device itself. Follow-up is necessary after implantation to provide individualized treatment and to detect malfunctions. Routine office visits, however, do not provide access to these data on a timely basis. Transtelephonic pace...

متن کامل

Pacemaker and arrhythmias in pediatric patients. An update

Arrhythmias in children are the enemy of any medical emergency. Different mechanisms should be very dangerous in particular for its adaptation mechanisms. Tachyarrhythmias (extrasistols, supraventricular tachycardia SVT, permanent junctional reciprocating tachycardia, atrial flutter, supraventricular tachycardias, ventricular tachycardias). Bradyarrhythmias (atrioventricular blocks) and channel...

متن کامل

Cardiac rhythm management devices (part II): perioperative management.

IN the first installment of this two-part communication, we reviewed the indications for an implanted pacemaker or internal cardioverter–defibrillator (ICD), provided a brief overview of how a device is selected, and described the basics of pacemaker and ICD design and function. Here we discuss specific device malfunction, electromagnetic and mechanical interference, and management for patients...

متن کامل

Pulsed electron avalanche knife (PEAK) PlasmaBlade™ in pacemaker and defibrillator procedures

BACKGROUND The pulsed electron avalanche knife (PEAK) PlasmaBlade™ is an innovative electrosurgical device that uses a novel technology to cut tissues. It has been proven to be safe and feasible in ear, nose, and throat surgery, but there are only limited data concerning the use of PlasmaBlade™ instead of conventional electrocautery in cardiac implantable electronic device (CIED) procedures exc...

متن کامل

ذخیره در منابع من


  با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید

برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

عنوان ژورنال:
  • Journal of thrombosis and haemostasis : JTH

دوره 6 10  شماره 

صفحات  -

تاریخ انتشار 2008