Key result
Heparin bridging and DAPT linked to significantly increased bleeding after CIED implantation.
Why the study?
Periprocedural management of antiplatelet or anticoagulation therapy at the time of pacemaker or ICD implantation remains controversial, motivating an assessment of bleeding complication risks across different medication regimens.
Does periprocedural dual antiplatelet therapy or heparin bridging increase the risk of significant bleeding complications in patients undergoing pacemaker or ICD implantation?
Cohort (n=1,388)
Does periprocedural dual antiplatelet therapy or heparin bridging increase the risk of significant bleeding complications in patients undergoing pacemaker or ICD implantation?
Dual antiplatelet therapy and periprocedural heparin bridging significantly increase the risk of bleeding complications during pacemaker or ICD implantation, whereas continuing warfarin with an INR >=1.5 showed no statistical difference in bleeding risk compared to holding warfarin.
Answers are grounded in this paper and cite their sources.
DAPT or heparin bridging may raise bleeding risk at device implantation; leaves open optimal periprocedural strategies pending randomized data.
Objectives This study was designed to assess the risk of significant bleeding complications in patients receiving antiplatelet or anticoagulation medications at the time of implantable cardioverter-defibrillator (ICD) device implantation. Background Periprocedural management of antiplatelet or anticoagulation therapy at the time of device implantation remains controversial. Methods We performed a retrospective chart review of bleeding complications in all patients undergoing ICD or pacemaker implantation from August 2004 to August 2007. Aspirin or clopidogrel use was defined as taken within 5 days of the procedure. A significant bleeding complication was defined as need for pocket exploration or blood transfusion; hematoma requiring pressure dressing or change in anticoagulation therapy; or prolonged hospitalization. Results Of the 1,388 device implantations, 71 had bleeding complications (5.1%). Compared with controls not taking antiplatelet agents (n = 255), the combination of aspirin and clopidogrel (n = 139) significantly increased bleeding risk (7.2% vs. 1.6%; p = 0.004). In patients taking aspirin alone (n = 536), bleeding risk was marginally higher than it was for patients taking no antiplatelet agents (3.9% vs. 1.6%, p = 0.078). The use of periprocedural heparin (n = 154) markedly increased risk of bleeding when compared with holding warfarin until the international normalized ratio (INR) was normal (n = 258; 14.3% vs. 4.3%; p < 0.001) and compared with patients receiving no anticoagulation therapy (14.3% vs.1.6%; p < 0.0001). There was no statistical difference in bleeding risk between patients continued on warfarin with an INR > or =1.5 (n = 46) and patients who had warfarin withheld until the INR was normal (n = 258; 6.5% vs. 4.3%; p = 0.50). Conclusions Dual antiplatelet therapy and periprocedural heparin significantly increase the risk of bleeding complications at the time of pacemaker or ICD implantation.
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TOMPKINS et al. (2010) conducted a cohort in Pacemaker or implantable cardioverter-defibrillator (ICD) device implantation (n=1,388). Periprocedural antiplatelet or anticoagulation therapy (dual antiplatelet therapy with aspirin and clopidogrel, or periprocedural heparin bridging) vs. No antiplatelet or anticoagulation therapy, or holding warfarin until INR was normal was evaluated on Significant bleeding complication (need for pocket exploration or blood transfusion; hematoma requiring pressure dressing or change in anticoagulation therapy; or prolonged hospitalization) (p=<0.001). Dual antiplatelet therapy and heparin bridging increased bleeding complications after pacemaker or ICD implantation.
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