Outpatient pacemaker procedures in orally anticoagulated patients

Daniel J. Goldstein, William Losquadro, Henry M. Spotnitz

Research output: Contribution to journalArticle

73 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1730-1734
Number of pages5
JournalPACE - Pacing and Clinical Electrophysiology
Volume21
Issue number9
DOIs
StatePublished - Sep 17 1998
Externally publishedYes

Keywords

  • Anticoagulation
  • Cephalic cutdown
  • Outpatient surgery
  • Pacemaker surgery

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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