Abstract 14904: Safety of Performing Same Day Implantable Cardioverter Defibrillator Implantation in Patients on Warfarin Anticoagulation
INTRODUCTION: Between 14 and 35% of patients undergoing Implantable Cardioverter Defibrillator (ICD) placement are on long term anticoagulation therapy. Recent data supports ICD implantation while on warfarin anticoagulation. Outpatient ICD implantation has also been performed at some centers without a significant increase in complications. We wanted to evaluate the safety and feasibility of outpatient ICD implantation on warfarin anticoagulated patients.
OBJECTIVE: To determine the safety of performing same day outpatient ICD implantation in patients who are on warfarin anticoagulation therapy.
METHODS: All patients undergoing same day ICD implantation, generator change, or upgrade, at our center between years 2010 & 2013 were included. Patient demographics and comorbidities in the anticoagulation group (AC Group) were compared to a second group of patients who were not on anticoagulation (NAC Group). To be included in the study, patients in the AC group had to have an INR between 1.5 and 3.5 within 24 hrs of the procedure. The composite primary outcome was significant bleeding necessitating additional intervention or anticoagulation cessation, or any adverse event associated with the procedure within 30 days following surgery.
RESULTS: We studied 453 patients (average age 71 years, 88 % male, mean EF 22%) who underwent outpatient ICD implantation, generator change, or upgrade. Of these, 128 patients (28%) met inclusion criteria for the AC group and the remainder 325 patients were included in the NAC group. Patient characteristics including age, gender, and EF were well matched between the AC group and NAC groups. In the AC group, there were 7 adverse events (5.4%) vs. 15 events (4.6%) in the NAC group (p=0.804).
CONCLUSION: Outpatient ICD implantation on warfarin anticoagulated patients is feasible and safe with no significant difference in adverse event rates as compared to those patients undergoing similar procedures off anticoagulation.
- © 2013 by American Heart Association, Inc.