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Document Details :

Title: Managing periprocedural anticoagulation therapy in patients undergoing device implantation: survey in Germany, Austria and Switzerland
Author(s): F. Blaschke , P. Lacour , A. Wutzler , M. Huemer , A.S. Parwani , P. Attanasio , B. Pieske , L.-H. Boldt , W. Haverkamp
Journal: Acta Cardiologica
Volume: 71    Issue: 5   Date: 2016   
Pages: 549-556
DOI: 10.2143/AC.71.5.3167498

Abstract :
Objective: The management of patients who undergo cardiac implantable electronic device (CIED) surgery and receive concomitant oral anticoagulation therapy (OAT) is an important clinical topic, as physicians must balance the thromboembolic and bleeding risk when deciding on the perioperative anticoagulation medication. The object of the survey was to analyse the management of perioperative OAT with vitamin K antagonists or novel oral anticoagulant agents (NOACs) and time, type and dose of possibly heparin bridging in consideration of OAT indication during CIED implantation in Austria, Germany and Switzerland.
Methods and results: We performed a web-based survey across CIED implanting centres in Germany, Austria and Switzerland to collect data regarding the management of the perioperative anticoagulation therapy. In total, the survey was completed by 252 centres. In total, 65.2% of the Austrian, 46.0% of the German and 13.3% of the Swiss centres stop vitamin K antagonists before CIED implantation and bridge with heparin, targeted to a therapeutic level, in most cases. NOACs were stopped before CIED implantation in most centres (95.8% of the Austrian, 89.5% of the German and 87.5% of the Swiss centres) surveyed without heparin bridging.
Conclusions: Previous meta-analyses showed that heparin bridging in patients undergoing CIED implantation increases the risk of bleeding complications compared to continuation of vitamin K antagonist treatment but data from our survey shows that interruption of vitamin K antagonist treatment and bridging with heparin remains a commonly employed strategy. Data regarding CIED implantation with uninterrupted NOACs are limited; thus, most centres surveyed stop NOACs before CIED implantation without heparin bridging.