Anticoagulation management of patients with long-term warfarin therapy after valve replacement during the perioperative period of pacemaker implantation

Background: To explore an optimal management of perioperative anticoagulation for patients with long-term warfarin therapy after valve replacement during the perioperative of pacemaker implantation. Methods: We retrospectively reviewed consecutive patients undergoing pacemaker implantation who received long-term warfarin therapy after valve replacements at our hospital. They were divided into 3 groups: discontinued group, bridging group and continued group. We analyzed the relationship between different anticoagulation methods during the peri-procedure period and hemorrhage and embolism events. Results: 132 patients were enrolled. There was no significant difference concerning the mean age, sex, concomitant diseases, atrial fibrillation and whether performed pacemaker replacement among 3 groups. The incidence of hematomas was irrespective of the perioperative anticoagulation strategy used (P = 0.125). A strategy involving bridging anticoagulation with therapeutic-dose heparin was associated with an incidence of wound errhysis (P = 0.008). There was no thromboembolism event in these three groups. Conclusion: The results showed that there was no significant difference in hematoma rate among continued group, discontinued group, and bridging group, but there was much more wound errhysis in the bridging group. Also, the study shows that if warfarin is continued, it will not increase the risk of bleeding when the International Normalized Ratio (INR) is around 1.7 during the procedure.