Key result
Suspension of warfarin <3 days before pacemaker implantation was associated with a higher incidence of excessive haemorrhage compared to suspension 3 days prior (31.4% vs 8.6%; P=0.003).
Why the study?
Does suspending warfarin for at least 3 days prior to surgery reduce perioperative complications compared to suspending it <3 days or not at all in patients with mechanical heart valves undergoing pacemaker implantation?
Cohort (n=109)
Does suspending warfarin for at least 3 days prior to surgery reduce perioperative complications compared to suspending it <3 days or not at all in patients with mechanical heart valves undergoing pacemaker implantation?
In patients with mechanical heart valves undergoing pacemaker implantation, suspending warfarin at least 3 days prior to surgery and avoiding post-operative low-molecular-weight heparin may reduce bleeding complications.
Answers are grounded in this paper and cite their sources.
Supports ≥3-day warfarin suspension pre-pacemaker implantation to limit bleeding; leaves open randomized validation in mechanical valve patients.
AIMS: This study was to evaluate perioperative anticoagulation therapy in patients with mechanic heart valve(s) undergoing pacemaker implantation. METHODS AND RESULTS: A total of 109 patients with mechanical heart valve(s) undertaking pacemaker implantation were studied. Fifty-one patients with warfarin suspended 3 days before surgery were classified into Group 1 and 58 patients with warfarin suspended <3 days or not at all into Group 2. The perioperative incidence of complications was compared. Suspension of warfarin<3 days before surgery was associated with a higher incidence of excessive haemorrhage (16/51 vs. 5/58, P=0.003). Patients with pocket haematoma were more likely to have been treated with post-operation heparin (60% vs. 17.3%, P=0.032). In 42 patients treated with proposed protocol of perioperative anticoagulation, no pocket haematoma or embolism occurred. CONCLUSIONS: A minimum of 3 days cessation of warfarin prior to surgery is preferred. Low-molecular-weight heparin should not be used for at least 3 days post-surgery. We propose that the protocol of perioperative anticoagulation be a suspension of warfarin not <3 days with low-molecular-weight heparin bridging stopped 12 h before surgery, and warfarin rather than low-molecular-weight heparin initiated immediately after surgery.
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Cheng et al. (2009) conducted a cohort in Mechanical heart valve(s) requiring pacemaker implantation (n=109). Suspension of warfarin <3 days before surgery or not at all vs. Suspension of warfarin 3 days before surgery was evaluated on Excessive haemorrhage (p=0.003). Suspension of warfarin <3 days before pacemaker implantation was associated with a higher incidence of excessive haemorrhage compared to suspension 3 days prior (31.4% vs 8.6%; P=0.003).
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