Continuing anticoagulants leads to less bleeding than heparin bridging strategy
MedWire News: Continuing anticoagulant therapy after cardiac rhythm device implantation leads to fewer bleeding complications than using a heparin bridging strategy (HBS), say researchers.
The findings are in contrast to current US guidelines, point out Michael Gold (Medical University of South Carolina, Charleston, USA) and team, who published their results in Circulation: Arrhythmia and Electrophysiology.
Current guidelines recommend HBS for anticoagulated patients with a moderate or high risk for thrombosis who undergo cardiac device implantation. However, several studies have reported a lower bleeding risk with continued oral anticoagulation compared with HBS. In addition, the best strategy for perioperative management of patients on antiplatelet therapy is less clear, the authors say.
They therefore conducted a meta-analysis of device implantation-associated bleeding complications using different anticoagulant and antiplatelet therapies.
The researchers pooled data from 13 studies and 5978 patients. Device recipients were grouped as no therapy (NT), aspirin only, anticoagulant held or International Normalized Ratio (INR) >1.5, anticoagulant continued or INR <1.5, dual antiplatelet therapy, or HBS.
The combined rate of bleeding complications, including hematoma, transfusion, or prolonged hospital stay was 3.7%.
After adjusting for study heterogeneity, the estimated odds for bleeding were increased 8.3-fold in the HBS group, 5.0-fold for dual antiplatelet therapy, 1.7-fold for anticoagulant held, 1.6-fold for anticoagulant continued, and 1.5-fold for aspirin only, relative to the NT group.
Patients who underwent HBS had a significant 5.3-fold increased risk for bleeding compared with those who received treatment with anticoagulants.
Continuing anticoagulant therapy did not significantly increase the risk for bleeding compared with NT, note the authors.
"The primary results of the present meta-analysis show that HBS and dual antiplatelet therapy are associated with significant perioperative bleeding risks with cardiac rhythm device implantation," remark the authors.
"We also noted a 5-fold increased bleeding risk with dual antiplatelet therapy."
Nonetheless, they add that their study should be interpreted in light of several limitations, including the lack of a standardized definition of bleeding complications, largely observational data, and the fact that the analysis did not adjust for pulse generator size.
By Piriya Mahendra