| Abstract [eng] |
Objective. To evaluate the safety and efficacy of peri-procedural utilization of anticoagulation therapy during implantable cardiac rhythm management device procedures. Methods. Randomized controlled trials and observational studies in English language published between 2015 and 2022 were included in the literature review. Studies, which compared different management strategies of long-term anticoagulation therapy during peri-procedural cardiac rhythm device implantation and compared the complications of bleeding and/or thromboembolic events, were selected and reviewed. Results. 2 randomised controlled trials, 3 post-hoc analyses of randomised controlled trials and 5 observational studies met the eligibility criteria. Studies analyzing non-vitamin K oral anticoagulants interruption versus continuation during peri-procedural implantable cardiac device surgery found no statistically significant difference in bleeding or thromboembolic complications between these strategies. Studies comparing non-vitamin K oral anticoagulants with vitamin K antagonists also displayed no statistically significant difference. A sub-analysis of one study comparing dabigatran versus warfarin with heparin bridging and without bridging, reported a lower risk of pocket hematoma with dabigatran when compared to warfarin with heparin bridging (risk difference -8.62%, 95% confidence interval -24.15 to -0.51%; P=0.034). Both bleeding and thromboembolic complications were rare and studies were underpowered to detect differences between groups. Conclusions. Traditional method of vitamin K antagonists interruption with heparin bridging is less safe than continuing vitamin K antagonists at therapeutic levels. Both continuation and interruption strategy of non-vitamin K anticoagulants during cardiac device surgery seems to be safe and appropriate. |
