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Periprocedural management of anticoagulation and antiplatelet therapies in patients undergoing electrophysiologic procedures

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Opinion statement

Electrophysiologic studies, radiofrequency ablation, and device implantations including pacemakers and defibrillators have become essential tools in the armamentarium of electrophysiologists. These procedures are being performed in patients with complex comorbidities, many of whom chronically take anticoagulation or antiplatelet agents. Careful management of anticoagulation before, during, and after electrophysiologic procedures including device implantations is critical to minimize bleeding and thrombotic complications and to optimize patient outcomes.

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References and Recommended Reading

  1. Bertaglia E, Zoppo F, Tondo C, et al.: Early complications of pulmonary vein catheter ablation for atrial fibrillation: a multicenter prospective registry on procedural safety. Heart Rhythm 2007, 4:1265–1271.

    Article  PubMed  Google Scholar 

  2. Cappato R, Calkins H, Chen SA, et al.: Worldwide survey of the methods, efficacy, and safety of catheter ablation for human atrial fibrillation. Circulation 2005, 111:1100–1105.

    Article  PubMed  Google Scholar 

  3. Spragg DD, Dalal D, Cheema A, et al.: Complications of catheter ablation for atrial fibrillation: incidence and predictors. J Cardiovasc Electrophysiol 2008, 19:627–631.

    Article  PubMed  Google Scholar 

  4. Calkins H, Brugada J, Packer DL, et al.: HRS/EHRA/ECAS expert Consensus Statement on catheter and surgical ablation of atrial fibrillation: recommendations for personnel, policy, procedures and follow-up. A report of the Heart Rhythm Society (HRS) Task Force on catheter and surgical ablation of atrial fibrillation. Heart Rhythm 2007, 4:816–861.

    Article  PubMed  Google Scholar 

  5. Davutoglu V, Kervancioglu S, Dinckal H, et al.: High incidence of occult femoral vein thrombosis related to multiple venous sheaths during electrophysiological studies. Heart 2004, 90:1061–1062.

    Article  PubMed  CAS  Google Scholar 

  6. Bonow RO, Carabello BA, Chatterjee K, et al.; American College of Cardiology/American Heart Association Task Force on Practice Guidelines: 2008 Focused update incorporated into the ACC/AHA guidelines for the management of patients with valvular heart disease. J Am Coll Cardiol 2008, 52e1–e142.

  7. Piazza G, Goldhaber SZ: Periprocedural management of the anticoagulated patient: critical pathways for bridging therapy. Crit Pathways Cardiol 2003, 2:96–103.

    Google Scholar 

  8. Fuster V, Ryden LE, Cannom DS, et al.: ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation-a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation). J Am Coll Cardiol 2006, 48:e149–e246.

    Article  Google Scholar 

  9. Kovacs MJ, Kearon C, Rodger M, et al.: Single-arm study of bridging therapy with low-molecular-weight heparin for patients at risk of arterial embolism who require temporary interruption of warfarin. Circulation 2004, 110:1658–1663.

    Article  PubMed  CAS  Google Scholar 

  10. He H, Kang J, Tao H, et al.: Conventional oral anticoagulation may not replace prior transesophageal echocardiography for the patients with planned catheter ablation for atrial fibrillation. J Interv Card Electrophysiol 2009, 24:19–26.

    Article  PubMed  Google Scholar 

  11. Wazni OM, Beheiry S, Fahmy T, et al.: Atrial fibrillation ablation in patients with therapeutic international normalized ratio. Circulation 2007, 116:2531–2534.

    Article  PubMed  Google Scholar 

  12. Shea JB: Anticoagulation practice in cardiac electrophysiology. Heart Rhythm 2006, 3:372–374.

    Article  PubMed  Google Scholar 

  13. Wang TL, Lin JL, Hwang JJ, et al.: The evolution of platelet aggregability in patients undergoing catheter ablation for supraventricular tachycardia with radiofrequency energy: the role of antiplatelet therapy. Pacing Clin Electrophysiol 1995, 18:1980–1990.

    Article  PubMed  CAS  Google Scholar 

  14. Michelucci A, Antonucci E, Conti AA, et al.: Electrophysiologic procedures and activation of the hemostatic system. Am Heart J 1999, 138:128–132.

    Article  PubMed  CAS  Google Scholar 

  15. Jesel L, Morel O, Pynn S, et al.: Radiofrequency catheter ablation of atrial flutter induces the release of platelet and leukocyte-derived procoagulant microparticles and a prothrombotic state. Pacing Clin Electrophysiol 2009, 32:193–200.

    Article  PubMed  Google Scholar 

  16. Wang LH, Jin ZM, Chen JZ, et al.: Effect of heparin on activation of platelet function in patients during radiofrequency catheter ablation. Clin Exp Pharmacol Physiol 2006, 33:66–70.

    Article  PubMed  CAS  Google Scholar 

  17. Dorbala S, Cohen AJ, Hutchinson LA, et al.: Does radiofrequency ablation induce a prethrombotic state? Analysis of coagulation system activation and comparison to electrophysiology study. J Cariovasc Electrophysiol 1998, 9:1152–1160.

    Article  CAS  Google Scholar 

  18. Khairy P, Chauvet P, Lehmann J, et al.: Lower incidence of thrombus formation with cryoenergy versus radiofrequency catheter ablation. Circulation 2003, 107:2045–2050.

    Article  PubMed  Google Scholar 

  19. Tse HF, Kwong YL, Lau CP: Transvenous cryoablation reduces platelet activation during pulmonary vein ablation compared with radiofrequency energy in patients with atrial fibrillation. J Cardiovasc Electrophysiol 2005, 16:1064–1070.

    Article  PubMed  Google Scholar 

  20. Hochholzer W, Schlittenhardt D, Arentz T, et al.: Platelet activation and myocardial necrosis in patients undergoing radiofrequency and cryoablation of isthmus-dependent atrial flutter. Europace 2007, 9:490–495.

    Article  PubMed  Google Scholar 

  21. Everett TH, Lee KW, Wilson EE, et al.: Safety profiles and lesion size of different radiofrequency ablation technologies: a comparison of large tip, open, and closed irrigation catheters. J Cardiovasc Electrophysiol 2009, 20:325–335.

    Article  PubMed  Google Scholar 

  22. Bruce CJ, Friedman PA, Narayan O, et al.: Early heparinization decreases the incidence of left atrial thrombi detected by intracardiac echocardiography during radiofrequency ablation for atrial fibrillation. J Interv Card Electrophysiol 2008, 22:211–219.

    Article  PubMed  Google Scholar 

  23. Anfinsen OG, Gjesdal K, Aass H, et al.: When should heparin preferably be administered during radiofrequency ablation? Pacing Clin Electrophysiol 2001, 24:5–12.

    Article  PubMed  CAS  Google Scholar 

  24. Ren JF, Marchlinski FE, Callans DJ, et al.: Increased intensity of anticoagulation may reduce risk of thrombus during atrial fibrillation ablation procedures in patients with spontaneous echo contrast. J Cardiovasc Electrophysiol 2005, 16:474–477.

    Article  PubMed  Google Scholar 

  25. Patel AA, Clyne CA, Henyan NN, et al.: The use of protamine after radiofrequency catheter ablation: a pilot study. J Interv Card Electrophysiol 2007, 18:155–158.

    Article  PubMed  Google Scholar 

  26. Stewart WJ, McSweeney SM, Kellett MA, et al.: Increased risk of severe protamine reactions in NPH insulindependent diabetics undergoing cardiac catheterization. Circulation 1984, 70:788–792.

    PubMed  CAS  Google Scholar 

  27. Doshi SK, Keane D, Mansour M, et al.: The use of Angioseal devices with prolonged catheter ablation procedures to permit uninterrupted anticoagulation [abstract]. Heart Rhythm 2005, 2:S239.

    Article  Google Scholar 

  28. Rossillo A, Bonso A, Themistoclakis S, et al.: Role of anticoagulation therapy after pulmonary vein antrum isolation for atrial fibrillation treatment. J Cardiovasc Med (Hagerstown) 2008, 9:51–55.

    Google Scholar 

  29. Reynolds MR, Cohen DJ, Kugelmass AD, et al.: The frequency and incremental cost of major complications among medicare beneficiaries receiving implantable cardioverter-defibrillators. J Am Coll Cardiol 2006, 47:2493–2497.

    Article  PubMed  Google Scholar 

  30. Wiegand U, LeJeune D, Boguschewski F, et al.: Pocket hematoma after pacemaker or implantable cardioverter defibrillator surgery. Chest 2004, 126:1177–1186.

    Article  PubMed  Google Scholar 

  31. Michaud GF, Pelosi F, Noble MD, et al.: A randomized trial comparing heparin initiation 6 h or 24 h after pacemaker or defibrillator implantation. J Am Coll Cardiol 2000, 35:1915–1918

    Article  PubMed  CAS  Google Scholar 

  32. Marquie C, De Geeter G, Klug D, et al.: Post-operative use of heparin increases morbidity of pacemaker implantation. Europace 2006, 8:283–287.

    Article  PubMed  CAS  Google Scholar 

  33. Robinson M, Healey JS, Eikelboom J, et al.: Postoperative low-molecular-weight heparin bridging is associated with an increase in wound hematoma following surgery for pacemakers and implantable defibrillators. Pacing Clin Electrophysiol 2009, 32:378–382.

    Article  PubMed  Google Scholar 

  34. Al-Khadra AS: Implantation of pacemakers and implantable cardioverter defibrillators in orally anticoagulated patients. Pacing Clin Electrophysiol 2003, 26:511–514.

    Article  PubMed  Google Scholar 

  35. Goldstein DJ, Losquadro W, Spotnitz HM: Outpatient pacemaker procedures in orally anticoagulated patients. Pacing Clin Electrophysiol 1998, 21:1730–1734.

    Article  PubMed  CAS  Google Scholar 

  36. Gage BF, Waterman AD, Shannon W, et al.: Validation of clinical classification schemes for predicting stroke: results from the National Registry of Atrial Fibrillation. JAMA 2001, 285:2864–2870.

    Article  PubMed  CAS  Google Scholar 

  37. Douketis JD, Berger PB, Dunn AS, et al.: The perioperative management of antithrombotic therapy: American College of Chest Physicians evidence-based clinical practice guidelines (8th edition). Chest 2008, 133:299S–339S.

    Article  PubMed  CAS  Google Scholar 

  38. Garcia DA, Regan S, Henault LE, et al.: Risk of thrombo-embolism with short-term interruption of warfarin therapy. Arch Intern Med 2008, 168:63–69.

    Article  PubMed  CAS  Google Scholar 

  39. Jamula E, Douketis JD, Schulman S: Perioperative anticoagulation in patients having implantation of a cardiac pacemaker or defibrillator: a systematic review and practical management guide. J Thromb Haemost 2008, 6:1615–1621.

    Article  PubMed  CAS  Google Scholar 

  40. Milic DJ, Perisic ZD, Zivic SS, et al.: Prevention of pocket related complications with fibrin sealant in patients undergoing pacemaker implantation who are receiving anticoagulant treatment. Europace 2005, 7:374–379.

    Article  PubMed  Google Scholar 

  41. Birnie D, Healey JS, Krahn A, et al.: Bridge or continue Coumadin for device surgery: a randomized controlled trial rationale and design. Curr Opin Cardiol 2008, 24:82–87.

    Article  Google Scholar 

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Authors and Affiliations

  1. Virginia Commonwealth University Medical Center, Gateway Building, 1200 East Marshall Street, Third Floor, Richmond, VA, 23219, USA

    Mark A. Wood

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  1. Jordana Kron
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  2. Daniel Alexander
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  3. Mark A. Wood
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Correspondence to Mark A. Wood.

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Kron, J., Alexander, D. & Wood, M.A. Periprocedural management of anticoagulation and antiplatelet therapies in patients undergoing electrophysiologic procedures. Curr Treat Options Cardio Med 11, 349–359 (2009). https://doi.org/10.1007/s11936-009-0035-3

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