Évaluation du risque hémorragique de différents protocoles d'anticoagulation péri-opératoire lors d'une primo-implantation ou un remplacement d'un stimulateur ou d'un défibrillateur cardiaque : analyse d'une cohorte de patients en centre hospitalier général

Aims: Perioperative management of anticoagulation in patients referred for pacemaker or cardiac defibrillator implantation isn't consensual. Our objective was to evaluate, in a large cohort, hemorrhagic complications in patients having implantation or replacement of a cardiac pacemaker or defibrillator, and to assess perioperative anticoagulation effect on hemorrhagic risk. Methods and results: A cohort of 461 consecutive patients having implantation or replacement of a cardiac pacemaker or defibrillator has been analyzed. Thirty patients (6,5%) had oral anticoagulants (OAC) switched to heparin/low-molecular-weight heparin, while 76 (16,5%) had their oral anticoagulation disrupted habitually for 48 hours. A total of six over 30 (20%) and two over 76 (2.6%) patients in the bridge and OAC, respectively experienced a pocket hematoma (bridge vs. OAC, p < 0.05), while ten over 355 (2.8%) had a pocket hematoma in the control group (bridge vs. control p = 0.006). Duration of the hospital stay was longer in the bridge group in comparison with OAC and control groups (9 vs. 7 vs. 6 days, respectively, p = 0.006). Conclusion: Oral anticoagulation bridging with heparin or low-molecular-weight heparin is associated with a higher risk of pocket hematoma and a longer duration of hospitalization, in comparison with a strategy allowing a temporary disruption of OAC adapted to the thromboembolic risk.