Continuous use of oral anticoagulation during CIED surgery significantly reduced the risk of postoperative bleeding compared with heparin bridging (OR 0.25; 95% CI 0.17-0.36; P<0.00001).
Meta-Analysis (n=2,191)
Does continuous oral anticoagulation reduce clinically significant bleeding compared to heparin bridging in patients undergoing CIED surgery?
Uninterrupted use of vitamin K antagonists during CIED surgery significantly reduces postoperative bleeding compared to heparin bridging without increasing thromboembolic risk.
Odds Ratio: 0.25 (95% CI 0.17–0.36)
p-value: p=< 0.00001
BACKGROUND: Management of patients treated with oral anticoagulation (OAC) requiring a cardiovascular implantable electronic device (CIED) surgery is a challenge that requires balancing the risk of bleeding complications with the risk of thromboembolic events. Recently the approach of performing these procedures while the patient remains with a therapeutic international normalized ratio has gained interest due to several publications showing its relative safety. OBJECTIVES: To evaluate the safety and effectiveness of continuous use of OAC compared with heparin bridging in the perioperative setting of CIED surgery using a meta-analysis. METHODS: A systematic review of PubMed/MEDLINE, Ovid, and Elsevier databases was performed. Eligible randomized controlled trials and cohort studies were included. The outcomes studied were risk of clinically significant bleeding and of thromboembolic events. Our analysis was restricted to OAC with vitamin K antagonists. RESULTS: Of 560 manuscripts initially considered relevant, seven were included in the meta-analysis, totaling 2,191 patients. Data are reported as odds ratios (ORs) with confidence interval (CI) of 95%. Maintenance of OAC was associated with a significantly lower risk of postoperative bleeding compared with heparin bridge (OR = 0.25, 95% CI 0.17-0.36, P < 0.00001). There was no difference noted in the risk of thromboembolic events between the two strategies (OR = 1.86, 95% CI 0.29-12.17, P = 0.57). CONCLUSIONS: Uninterrupted use of OAC in the perioperative of CIED surgery was associated with a reduced risk of bleeding. This strategy should be considered the preferred one in patients at moderate-to-high risk of thromboembolic events.
Sant’Anna et al. (Fri,) conducted a meta-analysis in Patients treated with oral anticoagulation requiring cardiovascular implantable electronic device (CIED) surgery (n=2,191). Continuous oral anticoagulation (vitamin K antagonists) vs. Heparin bridging was evaluated on Clinically significant bleeding (OR 0.25, 95% CI 0.17-0.36, p=< 0.00001). Continuous use of oral anticoagulation during CIED surgery significantly reduced the risk of postoperative bleeding compared with heparin bridging (OR 0.25; 95% CI 0.17-0.36; P<0.00001).