5 years ago

Perioperative Management of Oral Anticoagulation in Patients Undergoing Implantation of Subcutaneous Implantatble Defibrillator

The perioperative anticoagulation management for subcutaneous implantable cardioverter defibrillator (S-ICD) is still evolving. Objective 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 during 10/2012 to 6/2017. The most common indication for the implantation was primary prevention of sudden cardiac death. In 24 patients, warfarin was continued without any interruption (warfarin group). In 113 patients, no warfarin was used in the perioperative period (non-warfarin group). Incidence of clinically significant lateral pocket hematoma was compared in two groups. Results One hundred and thirty-seven patients underwent successful S-ICD implantation during the study period. Mean international normalized ratio (INR) was 1.83±0.47 in the warfarin group and 1.09±0.18 in the non-warfarin group. A total of eight patients developed hematoma at the lateral pocket. No patient developed hematoma at the parasternal pockets. Six (25 %) patients in the warfarin group and 2 (1.5 %) in the non-warfarin group developed significant lateral pocket hematoma (p = 0.001). Mean length of stay was longer in the warfarin group (1.23±0.46 days) compared to non-warfarin (1.02±0.18 days) group (p=0.0008). An INR > 1.8 predicted the risk of hematoma. Concomitant use of dual antiplatelet therapy (DAPT) did not increase the risk of hematoma. None of the patients with hematoma developed infection or required hematoma evacuation. Conclusion Uninterrupted warfarin in the perioperative period during S-ICD implantation is associated with increased risk of significant lateral pocket hematoma that results in prolonged hospital stay.

Publisher URL: www.sciencedirect.com/science

DOI: S1547527117313292

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