TY - JOUR
T1 - Perioperative management of oral anticoagulation in patients undergoing implantation of subcutaneous implantable cardioverter-defibrillator
AU - Afzal, Muhammad R.
AU - Mehta, Divyesh
AU - Evenson, Christopher
AU - Pinkhas, Daniel
AU - Badin, Auroa
AU - Patel, Dilesh
AU - Essandoh, Michael K.
AU - Godara, Hemant
AU - Tyler, Jaret
AU - Houmsse, Mahmoud
AU - Liu, Zhenguo
AU - Kalbfleisch, Steven J.
AU - Hummel, John D.
AU - Augostini, Ralph
AU - Weiss, Raul
AU - Daoud, Emile G.
AU - Okabe, Toshimasa
N1 - Publisher Copyright:
© 2017 Heart Rhythm Society
PY - 2018/4
Y1 - 2018/4
N2 - Background: The perioperative anticoagulation management during subcutaneous implantable cardioverter-defibrillator (S-ICD) implantation is still evolving. Objective: The purpose of this study was to assess whether it is safe to perform S-ICD implantation with uninterrupted warfarin. Methods: This is a single-center retrospective review of patients undergoing S-ICD implantation between October 1, 2012 and June 30, 2017. One hundred thirty-seven patients underwent successful S-ICD implantation during the study period. The most common indication for implantation was primary prevention of sudden cardiac death. In 24 (17.5%) patients, warfarin was continued without any interruption (warfarin group). In 113 (82.5%) patients, no warfarin was used in the perioperative period (nonwarfarin group). The incidence of clinically significant lateral pocket hematoma was compared in the 2 groups. Results: The mean international normalized ratio was 1.83 ± 0.47 in the warfarin group and 1.09 ± 0.18 in the nonwarfarin group. A total of 8 patients developed a hematoma at the lateral pocket. No patient developed a hematoma at the parasternal pockets. Six patients (25%) in the warfarin group and 2 (1.5%) in the nonwarfarin group developed a significant lateral pocket hematoma (P =.001). The mean length of stay was longer in the warfarin group (1.23 ± 0.46 days) than in the nonwarfarin group (1.02 ± 0.18 days) (P =.0008). An international normalized ratio of >1.8 predicted the risk of hematoma. The concomitant use of dual antiplatelet therapy did not increase the risk of hematoma. None of the patients with a hematoma developed infection or required hematoma evacuation. Conclusion: Uninterrupted warfarin in the perioperative period during S-ICD implantation is associated with an increased risk of significant lateral pocket hematoma that results in prolonged hospital stay.
AB - Background: The perioperative anticoagulation management during subcutaneous implantable cardioverter-defibrillator (S-ICD) implantation is still evolving. Objective: The purpose of this study was to assess whether it is safe to perform S-ICD implantation with uninterrupted warfarin. Methods: This is a single-center retrospective review of patients undergoing S-ICD implantation between October 1, 2012 and June 30, 2017. One hundred thirty-seven patients underwent successful S-ICD implantation during the study period. The most common indication for implantation was primary prevention of sudden cardiac death. In 24 (17.5%) patients, warfarin was continued without any interruption (warfarin group). In 113 (82.5%) patients, no warfarin was used in the perioperative period (nonwarfarin group). The incidence of clinically significant lateral pocket hematoma was compared in the 2 groups. Results: The mean international normalized ratio was 1.83 ± 0.47 in the warfarin group and 1.09 ± 0.18 in the nonwarfarin group. A total of 8 patients developed a hematoma at the lateral pocket. No patient developed a hematoma at the parasternal pockets. Six patients (25%) in the warfarin group and 2 (1.5%) in the nonwarfarin group developed a significant lateral pocket hematoma (P =.001). The mean length of stay was longer in the warfarin group (1.23 ± 0.46 days) than in the nonwarfarin group (1.02 ± 0.18 days) (P =.0008). An international normalized ratio of >1.8 predicted the risk of hematoma. The concomitant use of dual antiplatelet therapy did not increase the risk of hematoma. None of the patients with a hematoma developed infection or required hematoma evacuation. Conclusion: Uninterrupted warfarin in the perioperative period during S-ICD implantation is associated with an increased risk of significant lateral pocket hematoma that results in prolonged hospital stay.
KW - Perioperative anticoagulation
KW - Pocket hematoma
KW - Subcutaneous implantable defibrillator
KW - Sudden cardiac death
KW - Uninterrupted warfarin
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U2 - 10.1016/j.hrthm.2017.11.010
DO - 10.1016/j.hrthm.2017.11.010
M3 - Article
C2 - 29146276
AN - SCOPUS:85038614629
VL - 15
SP - 520
EP - 523
JO - Heart Rhythm
JF - Heart Rhythm
SN - 1547-5271
IS - 4
ER -