• Am. J. Cardiol. · Nov 2012

    Review Meta Analysis

    Meta-analysis of safety and efficacy of uninterrupted warfarin compared to heparin-based bridging therapy during implantation of cardiac rhythm devices.

    • Hamid Ghanbari, Wouter Saint Phard, Hazim Al-Ameri, Rakesh Latchamsetty, Krit Jongnarngsin, Thomas Crawford, Eric Good, Aman Chugh, Hakan Oral, Frank Bogun, Fred Morady, and Frank Pelosi.
    • Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA. ghhamid@umich.edu
    • Am. J. Cardiol. 2012 Nov 15;110(10):1482-8.

    AbstractOptimal management of perioperative anticoagulation in patients undergoing pacemaker or implantable cardioverter-defibrillator implantation is not yet established. We performed a meta-analysis of the published literature to assess the safety and efficacy of perioperative heparin-based bridging therapy versus uninterrupted warfarin therapy in patients undergoing pacemaker or implantable cardioverter-defibrillator implantation. We performed a systematic review of MEDLINE (1950 to 2012), EMBASE (1988 to 2012), Cochrane Controlled Trials Register (fourth quarter 2011), and reports presented at scientific meetings (1994 to 2011). Randomized controlled trials, case-control, or cohort studies comparing the safety and efficacy of uninterrupted warfarin therapy to heparin-based bridging therapy were eligible. Outcomes reported in eligible studies were rates of bleeding and thromboembolic events. Of 3,195 reports initially reviewed, we identified 8 studies enrolling 2,321 patients for the meta-analysis. Maintenance of therapeutic warfarin was associated with significantly lower bleeding postoperatively compared to heparin-based bridging therapy (odds ratio 0.30, 95% confidence interval 0.18 to 0.50, p <0.01). There was no significant difference in risk of thromboembolic events between these 2 strategies (odds ratio 0.65, 95% confidence interval 0.14 to 3.02, p = 0.58). In conclusion, strategy of uninterrupted warfarin therapy throughout pacemaker or implantable cardioverter-defibrillator implantation is associated with decreased risk of bleeding without increasing risk of thromboembolic events. This strategy is a viable alternative to heparin-based bridging therapy.Copyright © 2012 Elsevier Inc. All rights reserved.

      Pubmed     Full text   Copy Citation     Plaintext  

      Add institutional full text...

    Notes

     
    Knowledge, pearl, summary or comment to share?
    300 characters remaining
    help        
    You can also include formatting, links, images and footnotes in your notes
    • Simple formatting can be added to notes, such as *italics*, _underline_ or **bold**.
    • Superscript can be denoted by <sup>text</sup> and subscript <sub>text</sub>.
    • Numbered or bulleted lists can be created using either numbered lines 1. 2. 3., hyphens - or asterisks *.
    • Links can be included with: [my link to pubmed](http://pubmed.com)
    • Images can be included with: ![alt text](https://bestmedicaljournal.com/study_graph.jpg "Image Title Text")
    • For footnotes use [^1](This is a footnote.) inline.
    • Or use an inline reference [^1] to refer to a longer footnote elseweher in the document [^1]: This is a long footnote..

    hide…