Bleeding risk of submuscular ICD implantation with continued oral anticoagulation versus heparin bridging therapy
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Bleeding risk of submuscular ICD implantation with continued oral anticoagulation versus heparin bridging therapy. / Pecha, Simon; Ayikli, Ayhan; Wilke, Iris; Hakmi, Samer; Yildirim, Yalin; Gosau, Nils; Reichenspurner, Hermann; Willems, Stephan; Aydin, Muhammet Ali.
in: HEART VESSELS, Jahrgang 33, Nr. 4, 04.2018, S. 441-446.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Bleeding risk of submuscular ICD implantation with continued oral anticoagulation versus heparin bridging therapy
AU - Pecha, Simon
AU - Ayikli, Ayhan
AU - Wilke, Iris
AU - Hakmi, Samer
AU - Yildirim, Yalin
AU - Gosau, Nils
AU - Reichenspurner, Hermann
AU - Willems, Stephan
AU - Aydin, Muhammet Ali
PY - 2018/4
Y1 - 2018/4
N2 - Recent studies have shown that subcutaneous or subfascial pacemaker- and ICD implantation with continued oral anticoagulation therapy is associated with lower risk for bleeding complications, when compared to heparin bridging strategies. However, ICD generators are often implanted submuscularly. We therefore compared the bleeding risk with continued phenprocoumon therapy vs. heparin bridging in patients receiving submuscular ICD implantation. Between 01/2013 and 12/2013, 104 patients with need for oral anticoagulation received submuscular ICD or CRT-D implantation in our institution. 46 patients were implanted under continued phenprocoumon therapy while 58 patients received heparin bridging for implantation procedure. All ICD generators were placed submuscularly. The primary outcome of the study was clinically significant bleeding or device pocket hematoma with need for surgical revision. Mean patients age was 63.7 years, 72.1% were male. In patients with heparin bridging therapy, preoperative INR prior to ICD implantation was 1.2 ± 0.31 while in the group of patients on continued phenprocoumon therapy, mean pre-OP INR was 2.4 ± 0.47. In heparin bridging group, 8 (13.8%) patients experienced a clinically relevant pocket hematoma, while only 1 (2.2%) patient on continued phenprocoumon therapy needed surgical revision for pocket hematoma (P = 0.04). No further bleeding complications or clinically relevant pericardial effusion was observed in any of the groups and no perioperative thromboembolic event occurred. Submuscular ICD implantation under continued phenprocoumon therapy was safe and feasible. Compared to patients with heparin bridging therapy, those with continued phenprocoumon therapy had a lower incidence of clinically relevant bleeding complications.
AB - Recent studies have shown that subcutaneous or subfascial pacemaker- and ICD implantation with continued oral anticoagulation therapy is associated with lower risk for bleeding complications, when compared to heparin bridging strategies. However, ICD generators are often implanted submuscularly. We therefore compared the bleeding risk with continued phenprocoumon therapy vs. heparin bridging in patients receiving submuscular ICD implantation. Between 01/2013 and 12/2013, 104 patients with need for oral anticoagulation received submuscular ICD or CRT-D implantation in our institution. 46 patients were implanted under continued phenprocoumon therapy while 58 patients received heparin bridging for implantation procedure. All ICD generators were placed submuscularly. The primary outcome of the study was clinically significant bleeding or device pocket hematoma with need for surgical revision. Mean patients age was 63.7 years, 72.1% were male. In patients with heparin bridging therapy, preoperative INR prior to ICD implantation was 1.2 ± 0.31 while in the group of patients on continued phenprocoumon therapy, mean pre-OP INR was 2.4 ± 0.47. In heparin bridging group, 8 (13.8%) patients experienced a clinically relevant pocket hematoma, while only 1 (2.2%) patient on continued phenprocoumon therapy needed surgical revision for pocket hematoma (P = 0.04). No further bleeding complications or clinically relevant pericardial effusion was observed in any of the groups and no perioperative thromboembolic event occurred. Submuscular ICD implantation under continued phenprocoumon therapy was safe and feasible. Compared to patients with heparin bridging therapy, those with continued phenprocoumon therapy had a lower incidence of clinically relevant bleeding complications.
KW - Aged
KW - Anticoagulants/administration & dosage
KW - Arrhythmias, Cardiac/mortality
KW - Defibrillators, Implantable/adverse effects
KW - Drug Administration Routes
KW - Fascia
KW - Female
KW - Germany/epidemiology
KW - Heparin/administration & dosage
KW - Humans
KW - Male
KW - Postoperative Hemorrhage/chemically induced
KW - Prevalence
KW - Retrospective Studies
KW - Risk Assessment
KW - Survival Rate/trends
KW - Thromboembolism/prevention & control
U2 - 10.1007/s00380-017-1064-6
DO - 10.1007/s00380-017-1064-6
M3 - SCORING: Journal article
C2 - 29030709
VL - 33
SP - 441
EP - 446
JO - HEART VESSELS
JF - HEART VESSELS
SN - 0910-8327
IS - 4
ER -