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Peri-device Implantation Anticoagulation Management: Evidence and Clinical Implications

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Cardiac Arrhythmias

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Abstract

Implantation rates of cardiovascular implantable electronic devices (CIED) have increased over the past decade. A significant number of patients undergoing CIED implantation are treated with oral anticoagulants (OAC). The perioperative management of anticoagulant therapy is often challenging. Selecting a management strategy for anticoagulation therapy depends on a balance between the risk of hemorrhagic complications in the perioperative period and the risk of thrombotic complications. For patients with a low thrombotic risk, short-term interruption of OAC is recommended. For patients with moderate and higher risk of thrombotic complications, interruption of OAC could be unsafe, and bridging anticoagulation with parenteral agents is suggested. This approach, unfortunately, has serious limitations. For this reason, some physicians perform CIED implantation with OAC. However, the relative effectiveness and safety of both approaches remains to be determined by further randomized controlled trials. In this chapter, we provide the rationale for deciding on appropriate antithrombotic management strategy in the perioperative period, discuss advantages and disadvantages of each approach, underline existing evidence, and compare current guidelines for perioperative anticoagulant management. We also review the new oral anticoagulants such as direct thrombin inhibitors and factor Xa inhibitors and discuss implications regarding anticoagulation management during CIED implantation.

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Abbreviations

CIED:

Cardiovascular implantable electronic devices

CRT:

Cardiac resynchronization therapy

ICD:

Implantable cardiac defibrillator

LMWH:

Low-molecular-weight heparin

OAC:

Oral anticoagulant

TIA:

Transient ischemic attack

UFH:

Unfractionated heparin

VTE:

Venous thromboembolism

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Authors and Affiliations

  1. Division of Cardiology, McGill University Health Center, 1650 Cedar Ave., Room E5.200, Montreal, QC, H3G 1A4, Canada

    Alexander Omelchenko MD, Martin Bernier MD & Vidal Essebag MD, PhD, FRCPC, FACC

  2. Division of Cardiology, University of Ottawa, Heart Institute, 40 Ruskin Road, Ottawa, ON, K1Y 4W7, Canada

    David Birnie MB, ChB, MD

Authors
  1. Alexander Omelchenko MD
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  2. Martin Bernier MD
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  3. David Birnie MB, ChB, MD
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  4. Vidal Essebag MD, PhD, FRCPC, FACC
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Corresponding author

Correspondence to Vidal Essebag MD, PhD, FRCPC, FACC .

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Editors and Affiliations

  1. Department of Cardiology, Center Hospitalier Coutances, Coutances, France

    Ambrose S. Kibos

  2. Department of Internal Medicine Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA

    Bradley P. Knight

  3. Division of Cardiology, McGill University Health Center, Montreal, Québec, Canada

    Vidal Essebag

  4. Department of Cardiology, Miami Children's Hospital, Miami, Florida, USA

    Steven B. Fishberger

  5. School of Biology, Chemistry and Health, Manchester Metropolitan University, Manchester, United Kingdom

    Mark Slevin

  6. “Acad. Vasile Candea” Emergency Clinical Center for Cardiovascular Diseases, “Carol Davila” University of Medicine and Pharmacy, “Titu Maiorescu” University Faculty of Medicine,, Bucharest, Romania

    Ion C. Țintoiu

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Omelchenko, A., Bernier, M., Birnie, D., Essebag, V. (2014). Peri-device Implantation Anticoagulation Management: Evidence and Clinical Implications. In: Kibos, A., Knight, B., Essebag, V., Fishberger, S., Slevin, M., Țintoiu, I. (eds) Cardiac Arrhythmias. Springer, London. https://doi.org/10.1007/978-1-4471-5316-0_52

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