Intrinsic bleeding risk in patients with uninterrupted oral anticoagulation undergoing cardiac implantable electronic device procedures: A pilot study

摘要

The number of cardiac implantable electronic device (CIED) procedures is dramatically increasing worldwide [1]. Up to 37-46% of patients requiring device surgery are on chronic oral anticoagulation (OAC) therapy [2]. Perioperative anticoagulation management represents a dilemma for physicians, particularly in the subset of patients with moderate-to-high risk of arterial thromboembolic events. Current guidelines recommend interruption of anticoagulation and bridging with heparin [3]. However, such strategy has been associated with increased risk of pocket hematoma (up to 20%) [4]. More recently, observational studies showed that continuing warfarin for cardiac rhythm device implantation is safe and is associated with lower incidence of pocket hematoma [5,6]. Noteworthy, evidence from randomized controlled studies confirmed the efficacy and safety of uninterrupted OAC as compared with heparin bridging [7,8].