Abstract
Background: Implantable cardioverter-defibrillator
(ICD) surgery in patients
with implanted left ventricular assist devices (LVAD) is associated with an increased
risk of bleeding complications because of the need to ensure that these
patients are adequately anticoagulated. Our study aimed to evaluate the safety
of our new strategy of uninterrupted oral anticoagulation compared to heparin-bridging
during the surgical interval.
Methods: Between January 2009 and January 2020, 116 patients with LVAD
underwent ICD surgery. Since January 2015, 60 patients were operated under
continued sufficient oral anticoagulation with a vitamin k antagonist (VKA
group). Fifty-six
patients underwent a heparin-bridging
regimen (heparin group).
Demographics, perioperative data, complications, and mortality were analyzed.
Results: Bleeding complications attributable to the surgical intervention occurred
more often (19.6% vs. 10.0%, p = 0.142) and at a higher rate of re-exploratory
surgery
(14.3% vs. 5.0%, p = 0.088) in the heparin group without reaching statistical
significance. Moreover, the heparin group patients' postoperative total length of
stay was 10 days longer (17.8 ± 23.8 days vs. 8.3 ± 9.5 days, p = 0.007). There were
no procedure-related
deaths, no thromboembolic events, and no LVAD-related
thrombosis.
Conclusion: Our strategy of uninterrupted oral anticoagulation is safe and results
in a reduction by more than half the number of days in hospital without an
increase in adverse events.
| Identifer | oai:union.ndltd.org:DRESDEN/oai:qucosa:de:qucosa:88870 |
| Date | 05 January 2024 |
| Creators | Vondran, Maximilian, von Aspern, Konstantin, Garbade, Jens, Lässing, Johannes, Kiefer, Philipp, Rastan, Ardawan Julian, Borger, Michael Andrew, Schroeter, Thomas |
| Publisher | Wiley |
| Source Sets | Hochschulschriftenserver (HSSS) der SLUB Dresden |
| Language | English |
| Detected Language | English |
| Type | info:eu-repo/semantics/publishedVersion, doc-type:article, info:eu-repo/semantics/article, doc-type:Text |
| Rights | info:eu-repo/semantics/openAccess |
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