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Perioperative antithrombotic management during cardiac device implantation requires balancing hemorrhagic and thromboembolic risks.
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This review summarizes current evidence and recommendations for balancing bleeding and thrombotic risks when managing novel oral anticoagulants and newer antiplatelets during cardiac device implantation.
A substantial proportion of patients who undergo cardiac device implantation receive oral anticoagulation to prevent thromboembolism or antiplatelets to prevent thrombotic events. Anticoagulation and antiplatelets increase the risk of hemorrhagic complications, while discontinuation may increase thromboembolic risk and thrombotic events. With the introduction of non-vitamin K antagonist oral anticoagulant agents and the newer antiplatelet agents such as prasugrel or ticagrelor, the perioperative management of patients has become more challenging. In this article, we review the recent trials and meta-analysis and describe the available evidence, as well as the current recommendations in order to inform best practice. We also reinforce the importance of further trials in this complex and rapidly evolving area.
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Chousou et al. (2017) conducted a review in Patients receiving implantable cardiac devices on anticoagulation or antiplatelets. Perioperative management of anticoagulation and antiplatelet therapy was evaluated. Perioperative management of anticoagulation and antiplatelet therapy in patients receiving implantable cardiac devices requires careful balancing of hemorrhagic and thromboembolic risks.
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