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Article: Cardiac implantable electronic device surgery with interruption of warfarin forgoing post-operative bridging therapy in patients with moderate or high thromboembolic risks
Title | Cardiac implantable electronic device surgery with interruption of warfarin forgoing post-operative bridging therapy in patients with moderate or high thromboembolic risks |
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Authors | |
Issue Date | 2021 |
Publisher | BioMed Central Ltd. The Journal's web site is located at http://www.thrombosisjournal.com/home/ |
Citation | Thrombosis Journal, 2021, v. 19, article no. 28 How to Cite? |
Abstract | Background:
For patients taking warfarin and undergoing pacemaker or implantable cardioverter-defibrillator surgery, clinical evidence and guidelines support continuation of warfarin therapy, as opposed to interruption of warfarin therapy with heparin bridging. Interruption of warfarin without post-operative bridging therapy may be a feasible alternative but data is sparse.
Methods:
This is a single-arm observational study including adults who had interruption of warfarin therapy without post-operative bridging therapy for cardiac implantable electronic device (CIED) surgery performed between 2010 and 2019 in a tertiary referral hospital. The primary outcome was a composite of all-cause mortality, arterial or venous thromboembolic events. The secondary outcomes were clinically significant device-pocket hematoma and other procedural complications.
Results:
Of the 411 patients analysed including 257 patients (62.5%) who had mechanical heart valves, the primary outcome developed in 5 (1.2%) patients within 30 days after surgery, including death in 3 (0.7%) patients, transient ischemic attack in 1 (0.2%) patient and non-CNS embolism in 1 (0.2%) patient. Clinically significant hematomas occurred in 24 (5.8%) patients, including 15 (3.7%) requiring additional interruption of anti-coagulation and 6 (1.5%) requiring clot evacuation. Other procedural complications and bleeding events were rare (< 1%).
Conclusions:
Warfarin interruption without post-operative bridging therapy for CIED surgery was associated with low thromboembolic risks and acceptable bleeding risk. Randomized controlled trials are required to formulate an optimal approach to anti-coagulation management. |
Persistent Identifier | http://hdl.handle.net/10722/306710 |
ISSN | 2023 Impact Factor: 2.6 2023 SCImago Journal Rankings: 0.572 |
PubMed Central ID | |
ISI Accession Number ID |
DC Field | Value | Language |
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dc.contributor.author | Ng, AKY | - |
dc.contributor.author | Ng, PY | - |
dc.contributor.author | Tam, EWY | - |
dc.contributor.author | Siu, CW | - |
dc.contributor.author | Fan, K | - |
dc.date.accessioned | 2021-10-22T07:38:29Z | - |
dc.date.available | 2021-10-22T07:38:29Z | - |
dc.date.issued | 2021 | - |
dc.identifier.citation | Thrombosis Journal, 2021, v. 19, article no. 28 | - |
dc.identifier.issn | 1477-9560 | - |
dc.identifier.uri | http://hdl.handle.net/10722/306710 | - |
dc.description.abstract | Background: For patients taking warfarin and undergoing pacemaker or implantable cardioverter-defibrillator surgery, clinical evidence and guidelines support continuation of warfarin therapy, as opposed to interruption of warfarin therapy with heparin bridging. Interruption of warfarin without post-operative bridging therapy may be a feasible alternative but data is sparse. Methods: This is a single-arm observational study including adults who had interruption of warfarin therapy without post-operative bridging therapy for cardiac implantable electronic device (CIED) surgery performed between 2010 and 2019 in a tertiary referral hospital. The primary outcome was a composite of all-cause mortality, arterial or venous thromboembolic events. The secondary outcomes were clinically significant device-pocket hematoma and other procedural complications. Results: Of the 411 patients analysed including 257 patients (62.5%) who had mechanical heart valves, the primary outcome developed in 5 (1.2%) patients within 30 days after surgery, including death in 3 (0.7%) patients, transient ischemic attack in 1 (0.2%) patient and non-CNS embolism in 1 (0.2%) patient. Clinically significant hematomas occurred in 24 (5.8%) patients, including 15 (3.7%) requiring additional interruption of anti-coagulation and 6 (1.5%) requiring clot evacuation. Other procedural complications and bleeding events were rare (< 1%). Conclusions: Warfarin interruption without post-operative bridging therapy for CIED surgery was associated with low thromboembolic risks and acceptable bleeding risk. Randomized controlled trials are required to formulate an optimal approach to anti-coagulation management. | - |
dc.language | eng | - |
dc.publisher | BioMed Central Ltd. The Journal's web site is located at http://www.thrombosisjournal.com/home/ | - |
dc.relation.ispartof | Thrombosis Journal | - |
dc.rights | This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. | - |
dc.title | Cardiac implantable electronic device surgery with interruption of warfarin forgoing post-operative bridging therapy in patients with moderate or high thromboembolic risks | - |
dc.type | Article | - |
dc.identifier.email | Ng, PY: pyeungng@hku.hk | - |
dc.identifier.email | Siu, CW: cwdsiu@hkucc.hku.hk | - |
dc.identifier.email | Fan, K: yyfan@hkucc.hku.hk | - |
dc.identifier.authority | Ng, PY=rp02517 | - |
dc.identifier.authority | Siu, CW=rp00534 | - |
dc.description.nature | published_or_final_version | - |
dc.identifier.doi | 10.1186/s12959-021-00279-6 | - |
dc.identifier.pmid | 33926467 | - |
dc.identifier.pmcid | PMC8082611 | - |
dc.identifier.scopus | eid_2-s2.0-85104964533 | - |
dc.identifier.hkuros | 328490 | - |
dc.identifier.volume | 19 | - |
dc.identifier.spage | article no. 28 | - |
dc.identifier.epage | article no. 28 | - |
dc.identifier.isi | WOS:000645658100001 | - |
dc.publisher.place | United Kingdom | - |