L'implantation des stimulateurs et défibrillateurs cardiaques sous antivitamines K n'augmente pas le risque hémorragique

Objectives: This study was designed to assess the hypothesis that the implantation or the replacement of a cardiac stimulator or defibrillator in patients receiving oral anticoagulants with an INR ≥ 2 doesn't increase the hemorrhagic risk in comparison with patients for whom the treatment has been interrupted temporarily (INR < 2) or with patients not receiving anticoagulants (control group). Patients and results: We performed a retrospective chart review of bleeding complications in all patients undergoing pacemaker or ICD implantation or replacement between January 2007 and may 2009. In this cohort, 43 patients (10%) were implanted with an INR ≥ 2 while 36 patients (8%) were implanted with an INR < 2 and 352 patients (82%) didn't receive anticoagulants. No complication (0/36) has been observed in patients having an INR < 2, while 3/43 (7%) complications have been observed in patients with an INR ≥ 2 and 13/352 (3.7%) in patients in the control group (p=0.3093). Duration of the hospital stay was similar in the three groups: 6.2 days in patients with an INR < 2, 6.8 days in the group with an INR ≥ 2 and 6.2. days in the control group (p=0.686). Conclusion: Pacemaker and ICD implantation or replacement without withdrawing of oral anticoagulants and an INR ≥ 2 was not associated with an increase of the hemorrhagic risk.