Abstract 15471: Meta-Analysis of Anticoagulant and Anti-Thrombotic Strategies on Bleeding Complications After Cardiac Rhythm Device Implantation
Introduction: Many patients receiving pacemakers or ICDs have conditions requiring antiplatelet (AP) and/or anticoagulant (AC) therapy. Current guidelines recommend a heparin bridging strategy (HBS) for patients on AC with moderate/high risk for thrombosis. Single-center observational studies have shown increased bleeding events using HBS.
Methods: PubMeb and Cochrane Database searches identified suitable articles based on design, outcomes and available data. Device recipients were grouped according to peri-operative strategy as follows: no therapy (NT), aspirin only, AC held, AC continued, dual AP, HBS. The primary outcome was defined as a bleeding complication such as hematoma, transfusion or prolonged hospital stay.
Results: Eleven articles were identified for analysis. Bleeding incidences and odds ratios compared with NT are shown in the Table. HBS carried a significant increase in bleeding events compared with holding or continuing AC. Continuing AC did not confer a significant increase in bleeding events compared with device implantation on NT.
Conclusions: Continuing AC appears safer than HBS for device implantation. Dual AP therapy carries a significant risk of bleeding.
- © 2011 by American Heart Association, Inc.