Perioperative anticoagulation management in patients on chronic oral anticoagulant therapy undergoing cardiac devices implantation: a meta-analysis.
The perioperative anticoagulation strategy during cardiac implantable electronic devices (CIEDs) implantation is highly variable without consensus among implanting physicians. A systematic literature search was performed in MEDLINE, EMBASE, and the Cochrane Library to identify clinical trials in patients on chronic oral anticoagulant (OAC) therapy undergoing CIEDs implantation. Bleeding and thromboembolic events were compared among heparin bridging, continued OAC, and interrupted OAC groups. Data were expressed as relative risks (RRs) and 95% confidence intervals (CIs) using random effects model. According to the inclusion criteria, totally 14 studies involving 3,744 patients were identified and included in the study. The heparin bridging group showed a significantly higher risk of bleeding events (relative risk [RR] 3.10, 95% confidence interval [CI], 2.02-4.76, P < 0.00001), especially pocket hematoma (RR 3.58, 95% CI, 2.17-5.91, P < 0.00001), but no significantly lower incidence of thromboembolism (RR 1.16, 95% CI, 0.36-3.67, P = 0.81) compared with OAC continuation group. Meanwhile, both unfractionated heparin-bridged and low-molecular-weight heparin-bridged subgroup exhibited a higher risk of bleeding. There was no significant difference between OAC continuation and OAC interruption group in bleeding (RR 0.90, 95% CI, 0.65-1.24, P = 0.52) and thromboembolic (RR 0.57, 95% CI, 0.16-2.01, P = 0.38) complications. The OAC interruption group had an obviously lower incidence of bleeding in comparison with the heparin bridging group and no statistical significance was observed in thrombus occurrence. Implantation of CIEDs with continuous OAC therapy may offer the best option by combining the lower risk of bleeding with rare thromboembolism compared with heparin bridging and OAC interruption therapy.
['Du|Ling|L|', 'Zhang|Yong|Y|', 'Wang|Weizong|W|', 'Hou|Yinglong|Y|']
D000284:Administration, Oral D000925:Anticoagulants D017147:Defibrillators, Implantable D006493:Heparin D006801:Humans D010138:Pacemaker, Artificial D019990:Perioperative Care D011183:Postoperative Complications D019106:Postoperative Hemorrhage D019919:Prosthesis Implantation D013923:Thromboembolism
perioperative anticoagulation cardiac implantable electronic devices bleeding thromboembolism