Continuing warfarin for surgery
In related news, a new study suggests that continuing warfarin for pacemaker or defibrillator surgery is safer than heparin bridging. Nearly 700 patients with an annual risk of thromboembolic events of ≥ 5% who required pacemaker or defibrillator surgery were randomized to continued-warfarin treatment or bridging therapy with heparin. The primary outcome was clinically significant device-pocket hematoma, which occurred in 12 of 343 patients (3.5%) in the continued-warfarin group as compared with 54 of 338 (16.0%) in the heparin-bridging group. There was one episode of cardiac tamponade and one myocardial infarction in the heparin-bridging group and one stroke and one TIA in the continued warfarin group. This study was stopped early after interim analysis found that the primary outcome occurred four times as often in the heparin-bridging group. These findings suggest that a strategy of continued warfarin therapy at the time of pacemaker or defibrillator surgery markedly reduced incidence of clinically significant device pocket hematoma as compared with heparin bridging (N Engl J Med 2013;368:2084-2093).