What question did this study set out to answer?

To evaluate the perioperative safety and complication rates of implanting cardiac resynchronization therapy defibrillators (CRT-D) without interrupting therapeutic warfarin therapy.

February 18, 2010Pacing and Clinical ElectrophysiologyOpen Access

Cardiac Resynchronization Therapy Device Implantation in Patients with Therapeutic International Normalized Ratios

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Why the study?

Does uninterrupted warfarin therapy reduce pocket hematomas and length of stay compared to bridging therapy during CRT-D implantation in patients requiring chronic anticoagulation?

Population

123 consecutive patients requiring cardiac resynchronization therapy device implantation, including 49 at…

Comparison

Uninterrupted warfarin therapy during CRT-D… vs Anticoagulant bridging therapy or perioperative…

Design

Cohort

Follow-up

30 days postoperatively

Authors

HGHamid GhanbariElectrophysiology DFDustin FeldmanProvidence Hospital MSMartin SchmidtLeibniz Institute of Surface Engineering

Discussion

Member takes

Implication

Bridging was associated with more hematomas and longer stays; supports uninterrupted warfarin but leaves open randomized confirmation in CRT-D.

Key Points

To evaluate the perioperative safety and complication rates of implanting cardiac resynchronization therapy defibrillators (CRT-D) without interrupting therapeutic warfarin therapy.
Enrolled 123 consecutive patients undergoing CRT-D implantation, categorized into 49 high-thromboembolic-risk patients receiving continuous warfarin or heparin bridging and 74 low-risk controls undergoing warfarin cessation.
Assessed incidence of pocket hematomas, bleeding, thromboembolic events, and duration of hospital stay at discharge, 15 days, and 30 days postoperatively.
Pocket hematoma rates were significantly higher in the bridging arm compared to continuous warfarin and control arms (20.7% vs. 5.0% vs. 4.1%, P = 0.03).
Hospital length of stay was significantly longer for bridged patients compared to the continuous warfarin and control groups (3.7 ± 3.2 vs. 2.9 ± 2.7 vs. 1.6 ± 1.6 days, P < 0.001).
Patients with prosthetic mechanical mitral valves had a significantly increased incidence of pocket hematomas compared to those without (20% vs. 1.8%, P = 0.03), whereas device upgrades did not differ significantly from new implants (12% vs. 6.2%, P = NS).

Structured PICO

Does uninterrupted warfarin therapy reduce pocket hematomas and length of stay compared to bridging therapy during CRT-D implantation in patients requiring chronic anticoagulation?

Population

123 consecutive patients requiring cardiac resynchronization therapy device (CRT-D) implantation, including 49 at high risk for thromboembolic events and 74 at low risk.

Intervention

Uninterrupted warfarin therapy during CRT-D implantation

Comparator

Anticoagulant bridging therapy (intravenous heparin or low molecular weight heparin) or perioperative cessation of warfarin (control group)

Outcome

Pocket hematomas, thromboembolic events, and bleeding evaluated at discharge, 15, and 30 days postoperativelysafety

Performing CRT-D implantation without interrupting warfarin therapy is a safe alternative to routine bridging therapy, significantly reducing the risk of pocket hematomas and shortening hospital length of stay.

Cite This Study

Ghanbari et al. (2010) studied this question.

synapsesocial.com/papers/6a6f9aae26a7f98052dc3cd7 https://doi.org/10.1111/j.1540-8159.2010.02703.x

Topics

Anticoagulation in AF

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Implication

Bridging was associated with more hematomas and longer stays; supports uninterrupted warfarin but leaves open randomized confirmation in CRT-D.

Cardiac Resynchronization Therapy Device Implantation in Patients with Therapeutic International Normalized Ratios

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Topics

Cardiac Resynchronization Therapy Device Implantation in Patients with Therapeutic International Normalized Ratios

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Also Consider

Topics

Also Consider