TY - JOUR
T1 - Outpatient pacemaker procedures in orally anticoagulated patients
AU - Goldstein, Daniel J.
AU - Losquadro, William
AU - Spotnitz, Henry M.
N1 - Copyright:
Copyright 2007 Elsevier B.V., All rights reserved.
PY - 1998
Y1 - 1998
N2 - Reexamination of surgical practices in the present era of cost containment has led to increased outpatient procedures including pacemaker surgery. While the safety and economic benefits of outpatient pacemaker surgery in nonanticoagulated patients is well documented, results of pacemaker operations in patients maintained on coumadin for thromboembolic prophylaxis have not been evaluated. In patients where complications with pacemaker surgery appeared successive, we have established a low incidence of complications. Recently, we extended this approach to the outpatient setting; this report retrospectively reviews our 4-year experience. During the study period, 150 patients underwent outpatient pacemaker procedures, including 37 patients receiving oral warfarin. There was no difference in the incidence of wound related and wound unrelated complications between patients receiving warfarin and the nonanticoagulated cohort. In addition, no wound hematomas, blood transfusions, or clinically significant bleeding episodes were noted among warfarin recipients. We conclude that pacemaker surgery in patients receiving oral anticoagulation is safe and feasible. The use of the cephalic cutdown technique avoiding blind subclavian punctures, meticulous attention to pocket hemostasis, and the use of small caliber unipolar positive fixation leads appears warranted in this selected group of patients at high risk for perioperative bleeding.
AB - Reexamination of surgical practices in the present era of cost containment has led to increased outpatient procedures including pacemaker surgery. While the safety and economic benefits of outpatient pacemaker surgery in nonanticoagulated patients is well documented, results of pacemaker operations in patients maintained on coumadin for thromboembolic prophylaxis have not been evaluated. In patients where complications with pacemaker surgery appeared successive, we have established a low incidence of complications. Recently, we extended this approach to the outpatient setting; this report retrospectively reviews our 4-year experience. During the study period, 150 patients underwent outpatient pacemaker procedures, including 37 patients receiving oral warfarin. There was no difference in the incidence of wound related and wound unrelated complications between patients receiving warfarin and the nonanticoagulated cohort. In addition, no wound hematomas, blood transfusions, or clinically significant bleeding episodes were noted among warfarin recipients. We conclude that pacemaker surgery in patients receiving oral anticoagulation is safe and feasible. The use of the cephalic cutdown technique avoiding blind subclavian punctures, meticulous attention to pocket hemostasis, and the use of small caliber unipolar positive fixation leads appears warranted in this selected group of patients at high risk for perioperative bleeding.
KW - Anticoagulation
KW - Cephalic cutdown
KW - Outpatient surgery
KW - Pacemaker surgery
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U2 - 10.1111/j.1540-8159.1998.tb00271.x
DO - 10.1111/j.1540-8159.1998.tb00271.x
M3 - Article
C2 - 9744435
AN - SCOPUS:0031719955
SN - 0147-8389
VL - 21
SP - 1730
EP - 1734
JO - PACE - Pacing and Clinical Electrophysiology
JF - PACE - Pacing and Clinical Electrophysiology
IS - 9
ER -