Warfarin continuation vs interruption during procedures of cardiac rhythm devices: A Meta-analysis of randomized controlled trials

J Pak Med Assoc. 2016 Apr;66(4):458-65.

Abstract

To compare the safetyand efficacy of warfarin treatment continuation and heparin-bridging therapy during cardiac rhythm device (CRD) implantation in patients chronically treated with anticoagulants.We performed a search and analysis of peer-reviewed studies Four randomized controlled trials (RCTs)were included in our analysis with 941 patients. The bleeding risk in patients continuing warfarin perioperatively was lower than those interrupting warfarin and using a heparin-bridge (RD -0.08, 95% CI -0.17 to 0.02, p< 0.05). There was no significant difference in ischaemic risk between two methods (RD 0, 95% CI -0.01 to 0.02, p=1.00). Hence, in patients undergoing long-term warfarin therapy, continuation of warfarin treatment is a safe and efficacious perioperative strategy for during CRD implantations, while interruption of warfarin with a heparin bridge may increase the bleeding risk in these patients.

Keywords: Warfarin, Pacemaker, Artificial, Perioperative period..

Publication types

  • Meta-Analysis
  • Review

MeSH terms

  • Anticoagulants / therapeutic use*
  • Blood Loss, Surgical / statistics & numerical data*
  • Hematoma / epidemiology*
  • Heparin / therapeutic use*
  • Humans
  • Pacemaker, Artificial*
  • Perioperative Care / methods*
  • Postoperative Hemorrhage / epidemiology*
  • Prosthesis Implantation / methods*
  • Randomized Controlled Trials as Topic
  • Warfarin / therapeutic use*

Substances

  • Anticoagulants
  • Warfarin
  • Heparin