![]() ![]() This observation led to the BRUISE CONTROL I (Bridge or Continue Coumadin for Device Surgery Randomized Controlled Trial, BC-1). Subsequently, numerous observational studies, including one from our group, 4 have shown that uninterrupted Coumadin at the time of CIED implant appeared to have a lower DPH event rate as compared with discontinuing Coumadin with heparin bridging. Uninterrupted Coumadin Versus Heparin Bridgingįor many years, discontinuation of anticoagulation with or without heparin bridging was required in patients who undergo CIED implant because of the fear of periprocedural DPH. ![]() DPH is fraught with several issues including patient comorbidities such as pain/discomfort, need for pocket reintervention for hematoma evacuation, increased infection risk, and significant costs associated with length of hospitalization and additional procedures. The concern that comes to fruition at the time of CIED implantation is the risk of not achieving adequate hemostasis intraprocedurally, as well as the risk of postimplant device pocket hematoma (DPH). In patients with high stroke risk, heparin bridging can be used in the perioperative setting. Continuation of anticoagulation confers stroke prophylaxis, whereas antiplatelet continuation is necessary in those with recent stent placement. This comes as no surprise as patients requiring cardiac implantable electronic devices (CIEDs) are older and more often have comorbidities such as atrial fibrillation, ischemic cardiomyopathy, or both. The use of oral anticoagulation and antiplatelet therapy is common among patients undergoing placement of pacemakers or defibrillators.
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