Anticoagulation Management in the Perioperative Phase of Implantable Cardioverter Defibrillator Implantation
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概要
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Background: According to the current guidelines, substitution of warfarin with heparin is recommended as perioperative management in patients with high risk of thromboembolism. Optimal management of oral anticoagulation in patients undergoing implantable cardioverter defibrillator (ICD) implantation, however, remains controversial. Methods and Results: Bleeding complications among 273 consecutive patients undergoing initial ICD implantation were retrospectively analyzed. Patients were grouped according to medication at the time of device implantation: neither antiplatelet nor anticoagulation (N group, n=121); antiplatelet only (AP group, n=59); warfarin (W group, n=59); and heparin bridging (H group, n=34). The rate of the major bleeding complications, defined as hematoma requiring reoperation, cardiac tamponade, and pericardial effusion requiring additional hospital stay, was 1.7% in the N group, 0% in the AP group, 5.1% in the W group, and 17.6% in the H group (P<0.001, N group vs. H group). After multivariate adjustment, heparin bridging was a significant predictor of major bleeding complications (odds ratio, 7.44; 95% confidence interval: 2.06–26.89; P=0.0022). The international normalized ratio of 3 patients in the W group with major bleeding complications was 1.98±0.10, and was significantly higher than in patients without them (1.31±0.05, n=26, P<0.001). Conclusions: Heparin bridging increased the risk of bleeding complications at the time of ICD implantation.
- 社団法人 日本循環器学会の論文
著者
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Yokoshiki Hisashi
Department Of Cardiovascular Medicine Hokkaido University Graduate School Of Medicine
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Tsutsui Hiroyuki
Department Of Cardiovascular Medicine
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Matsui Yoshiro
Department Of Cardiac Surgery Hokkaido University Hospital
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Mitsuyama Hirofumi
Department Of Cardiovascular Medicine Hokkaido University Graduate School Of Medicine
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Watanabe Masaya
Department Of Cardiovascular Medicine Hokkaido University Graduate School Of Medicine
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Mizukami Kazuya
Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
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TSUTSUI Hiroyuki
Department of Cardiology, Iizuka Hospital
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