What question did this study set out to answer?

To determine whether patients undergoing permanent pacemaker or implantable cardioverter defibrillator (ICD) implantation require periprocedural normalization of anticoagulation factors.

March 1, 2004Pacing and Clinical Electrophysiology

Pacemaker and Implantable Cardioverter Defibrillator Implantation Without Reversal of Warfarin Therapy

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Why the study?

Does permanent pacemaker and ICD implantation without reversal of warfarin therapy increase complication rates in patients requiring device placement?

Population

1,025 consecutive patients undergoing permanent pacemaker and ICD implantation over a 4-year period.

Comparison

Device implantation without reversal of warfarin… vs Device implantation in patients with a normal INR.

Design

Cohort

Follow-up

periprocedural period

Authors

MGMichael GiudiciUniversity of Primorska SBS. Serge BaroldElectrophysiology DPDEBORAH L. PAULGenesis Health System

Discussion

Member takes

Implication

May support omitting periprocedural anticoagulation reversal in device implantation; leaves open need for randomized confirmation.

Key Points

To determine whether patients undergoing permanent pacemaker or implantable cardioverter defibrillator (ICD) implantation require periprocedural normalization of anticoagulation factors.
Evaluated 1,025 consecutive patients (597 men, 428 women; age 24–100 years, mean 72 years) undergoing device implantation over a 4-year period, predominantly via a percutaneous subclavian approach.
Conducted device implantations without anticoagulation reversal in 470 patients with an international normalized ratio (INR) ≥ 1.5 at the time of procedure (mean INR 2.6 ± 1.0, range 1.5–7.5) and compared outcomes to patients with normal INR.
Complication rates among anticoagulated patients (INR ≥ 1.5) were comparable to rates observed in patients with normal INR values.
Routine normalization of coagulation factors prior to pacemaker and ICD placement may be safely omitted.

Structured PICO

Does permanent pacemaker and ICD implantation without reversal of warfarin therapy increase complication rates in patients requiring device placement?

Population

1,025 consecutive patients (597 men, 428 women, mean age 72 years, range 24-100) undergoing permanent pacemaker and ICD implantation over a 4-year period.

Intervention

Device implantation (mostly percutaneous subclavian approach) without reversal of warfarin therapy in patients with INR ≥ 1.5 at the time of the procedure (n=470).

Comparator

Device implantation in patients with a normal INR.

Outcome

Periprocedural complication rate.safety

Performing pacemaker and ICD implantation without reversing warfarin therapy does not appear to increase periprocedural complication rates compared to patients with normal INR.

Cite This Study

Giudici et al. (2004) studied this question.

synapsesocial.com/papers/6a6f9ab126a7f98052dc3cde https://doi.org/10.1111/j.1540-8159.2004.00441.x

Topics

Cardiac device therapy Anticoagulation in AF

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Pacemaker and Implantable Cardioverter Defibrillator Implantation Without Reversal of Warfarin Therapy

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Topics

Pacemaker and Implantable Cardioverter Defibrillator Implantation Without Reversal of Warfarin Therapy

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Also Consider

Topics

Also Consider