PMID- 22534249
OWN - NLM
STAT- MEDLINE
DCOM- 20120904
LR  - 20220409
IS  - 1941-3084 (Electronic)
IS  - 1941-3149 (Print)
IS  - 1941-3084 (Linking)
VI  - 5
IP  - 3
DP  - 2012 Jun 1
TI  - Meta-analysis of bleeding complications associated with cardiac rhythm device 
      implantation.
PG  - 468-74
LID - 10.1161/CIRCEP.111.969105 [doi]
AB  - BACKGROUND: Many patients receiving cardiac rhythm devices have conditions 
      requiring antiplatelet (AP) and/or anticoagulant (AC) therapy. Current guidelines 
      recommend a heparin-bridging strategy (HBS) for anticoagulated patients with 
      moderate/high risk for thrombosis. Several studies reported lower bleeding risk 
      with continued oral anticoagulation rather than HBS. The best strategy for 
      perioperative management of patients on AP therapy is less clear. The present 
      study was designed as a meta-analysis of device implantation-associated bleeding 
      complications using different AC/AP therapies. METHODS AND RESULTS: PubMed and 
      Cochrane Database searches identified articles based on design, outcomes, and 
      available data. Device recipients were grouped as follows: no therapy, aspirin 
      only, AC held, AC continued, dual AP, and HBS. The primary outcome was defined as 
      a bleeding complication including hematoma, transfusion, or prolonged hospital 
      stay. Thirteen articles were identified for analysis including 5978 patients. The 
      combined incidence of bleeding complications was 274 of 5978 (4.6%), ranging from 
      2.2% (no therapy) to 14.6% (HBS). The estimated odds of bleeding were increased 
      by 8.3 (95% CI, 5.5-12.9) times in the HBS group, 5.0 (95% CI, 3.0-8.3) for dual 
      AP therapy, 1.7 (95% CI, 1.0-3.1) for AC held, 1.6 (95% CI, 0.9-2.6) for AC 
      continued, and 1.5 (95% CI, 0.9-2.3) for aspirin only relative to the no therapy 
      group. HBS significantly increased bleeding events compared with holding or 
      continuing AC. Continuing AC did not increase bleeding events compared with no 
      therapy. CONCLUSIONS: Continuing AC appears safer than HBS for device 
      implantation. Dual AP therapy but not continuing AC carries a significant risk of 
      bleeding.
FAU - Bernard, Michael L
AU  - Bernard ML
AD  - Division of Cardiology, Medical University of South Carolina, Charleston, SC 
      29425, USA.
FAU - Shotwell, Matthew
AU  - Shotwell M
FAU - Nietert, Paul J
AU  - Nietert PJ
FAU - Gold, Michael R
AU  - Gold MR
LA  - eng
GR  - UL1 RR029882/RR/NCRR NIH HHS/United States
GR  - UL1RR029882/RR/NCRR NIH HHS/United States
PT  - Journal Article
PT  - Meta-Analysis
PT  - Research Support, N.I.H., Extramural
PT  - Review
DEP - 20120424
PL  - United States
TA  - Circ Arrhythm Electrophysiol
JT  - Circulation. Arrhythmia and electrophysiology
JID - 101474365
RN  - 0 (Anticoagulants)
SB  - IM
MH  - Anticoagulants/administration & dosage/*adverse effects
MH  - Arrhythmias, Cardiac/*therapy
MH  - *Defibrillators, Implantable
MH  - Hemorrhage/*chemically induced/epidemiology
MH  - Humans
MH  - *Pacemaker, Artificial
MH  - Practice Guidelines as Topic
MH  - Prevalence
MH  - Risk Factors
MH  - Thrombosis/prevention & control
PMC - PMC3626087
MID - NIHMS385362
EDAT- 2012/04/27 06:00
MHDA- 2012/09/05 06:00
PMCR- 2013/06/01
CRDT- 2012/04/27 06:00
PHST- 2012/04/27 06:00 [entrez]
PHST- 2012/04/27 06:00 [pubmed]
PHST- 2012/09/05 06:00 [medline]
PHST- 2013/06/01 00:00 [pmc-release]
AID - CIRCEP.111.969105 [pii]
AID - 10.1161/CIRCEP.111.969105 [doi]
PST - ppublish
SO  - Circ Arrhythm Electrophysiol. 2012 Jun 1;5(3):468-74. doi: 
      10.1161/CIRCEP.111.969105. Epub 2012 Apr 24.