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Europace Advance Access originally published online on August 6, 2009
Europace 2009 11(9):1183-1187; doi:10.1093/europace/eup212
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org.

Pacing and CRT

Perioperative anticoagulation for patients with mechanic heart valve(s) undertaking pacemaker implantation

Min Cheng, Wei Hua, Keping Chen, Jielin Pu, Xiaoqing Ren, Xinran Zhao, Zhimin Liu, Fangzheng Wang, Xin Chen and Shu Zhang*

Clinical EP. Lab and Arrhythmia Center, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Beijing 100037, China

Aims: This study was to evaluate perioperative anticoagulation therapy in patients with mechanic heart valve(s) undergoing pacemaker implantation.

Methods and resluts: A total of 109 patients with mechanical heart valve(s) undertaking pacemaker implantation were studied. Fifty-one patients with warfarin suspended 3 days before surgery were classified into Group 1 and 58 patients with warfarin suspended <3 days or not at all into Group 2. The perioperative incidence of complications was compared. Suspension of warfarin <3 days before surgery was associated with a higher incidence of excessive haemorrhage (16/51 vs. 5/58, P = 0.003). Patients with pocket haematoma were more likely to have been treated with post-operation heparin (60% vs. 17.3%, P = 0.032). In 42 patients treated with proposed protocol of perioperative anticoagulation, no pocket haematoma or embolism occurred.

Conclusions: A minimum of 3 days cessation of warfarin prior to surgery is preferred. Low-molecular-weight heparin should not be used for at least 3 days post-surgery. We propose that the protocol of perioperative anticoagulation be a suspension of warfarin not <3 days with low-molecular-weight heparin bridging stopped 12 h before surgery, and warfarin rather than low-molecular-weight heparin initiated immediately after surgery.

Key Words: Mechanical heart valve, Anticoagulation, Pacemaker implantation

* Corresponding author. Tel: +86 10 6833 4688, Fax: +86 10 6833 4688, Email: zsfuwai{at}vip.163.com

Manuscript submitted 28 May 2009. Accepted after revision 10 July 2009.


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