Abstract 14851: Oral Anticoagulation Continuation vs Heparin Bridging During Cardiac Rhythm Device Procedures: Less Pocket Hematomas - Meta-analysis of Randomized Trials
Background and Objectives: Management of patients with high thrombo-embolic (TE) risk on long-term oral anticoagulation (OAC) during cardiac rhythm devices procedures is controversial. Current guidelines recommend discontinuation of OAC and bridging with heparin; however recent studies reported an increased risk of bleeding associated with heparin bridging. We performed a meta-analysis of randomized controlled trials (RCTs) to compare these 2 strategies for bleeding and TE outcomes.
Methods: We searched PubMed and Scopus databases till May 2014 for RCTs that compared OAC continuation versus interruption with heparin bridging in high risk patients on OAC during devices procedures. Odds ratios (ORs) with 95% confidence interval (CI) for clinically significant pocket hematomas and TE events were calculated using fixed-effects model. We used mean difference to study the difference in length of stay (LOS) in the hospital between the 2 groups.
Results: Four RCTs were included in this analysis with 444 patients assigned to the OAC continuation group and 436 patients to the bridging group. We observed a 79% reduction in the odds of clinically significant hematomas (OR: 0.21, 95% CI, 0.11-0.37; p<0.00001) and a significant decrease in LOS (mean difference -1.28, 95% CI -2.02 to -0.55, p=0.0006) in the OAC group compared to heparin bridging. There was no difference in the rate of TE events between the 2 groups (p=0.19).
Conclusion: OAC continuation in patient on chronic anticoagulation during cardiac device procedures is safe and associated with decreased LOS in the hospital.
Author Disclosures: G. El-Hayek: None. A. Casso Dominguez: None. M. Pierce: None. A. Benjo: None. D. Garcia: None. E. Herzog: Speakers Bureau; Modest; Astra Zeneca, Daiichi Sankyo and Bristol Myers Squibb.. C. Barrett: None. R. Altman: None. J. Suk Danik: None. S. Danik: None.
- © 2014 by American Heart Association, Inc.