Anticoagulation management in the perioperative phase of implantable cardioverter defbrillator implantation

Hisashi Yokoshiki, Hirofumi Mitsuyama, Masaya Watanabe, Kazuya Mizukami, Yoshiro Matsui, Hiroyuki Tsutsui

Research output: Contribution to journalArticlepeer-review

11 Citations (Scopus)


Background: According to the current guidelines, substitution of warfarin with heparin is recommended as perioperative management in patients with high risk of thromboembolism. Optimal management of oral anticoagulation in patients undergoing implantable cardioverter defibrillator (ICD) implantation, however, remains controversial. Methods and Results: Bleeding complications among 273 consecutive patients undergoing initial ICD implantation were retrospectively analyzed. Patients were grouped according to medication at the time of device implantation: neither antiplatelet nor anticoagulation (N group, n=121); antiplatelet only (AP group, n=59); warfarin (W group, n=59); and heparin bridging (H group, n=34). The rate of the major bleeding complications, defined as hematoma requiring reoperation, cardiac tamponade, and pericardial effusion requiring additional hospital stay, was 1.7% in the N group, 0% in the AP group, 5.1% in the W group, and 17.6% in the H group (P<0.001, N group vs. H group). After multivariate adjustment, heparin bridging was a significant predictor of major bleeding complications (odds ratio, 7.44; 95% confidence interval: 2.06-26.89; P=0.0022). The international normalized ratio of 3 patients in the W group with major bleeding complications was 1.98±0.10, and was significantly higher than in patients without them (1.31±0.05, n=26, P<0.001). Conclusions: Heparin bridging increased the risk of bleeding complications at the time of ICD implantation.

Original languageEnglish
Pages (from-to)2003-2008
Number of pages6
JournalCirculation Journal
Issue number8
Publication statusPublished - 2013
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine


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