Afzal MR, et al. - This single-center retrospective review was designed to investigate the safety of perioperative anticoagulation management with uninterrupted warfarin in patients undergoing subcutaneous implantable cardioverter defibrillator (S-ICD) implantation. In those who received uninterrupted warfarin in the perioperative period during S-ICD implantation, increased risk of significant lateral pocket hematoma leading to prolonged hospital stay was noted.

Methods

• A single-center retrospective review was performed including patients undergoing S-ICD implantation during 10/2012 to 6/2017.
• Primary prevention of sudden cardiac death was the most common indication for the implantation.
• Warfarin group comprised 24 patients, in whom, warfarin was continued without any interruption.
• Non-warfarin group comprised 113 patients who did not receive warfarin in the perioperative period.
• In both groups, incidence of clinically significant lateral pocket hematoma was compared.

Results

• Overall, 137 patients underwent successful S-ICD implantation.
• The mean international normalized ratio (INR) was 1.83±0.47 and 1.09±0.18 in the warfarin group and non-warfarin group, respectively.
• Hematoma development at the lateral pocket was reported in 8 patients.
• As per data, no patient developed hematoma at the parasternal pockets.
• Development of significant lateral pocket hematoma (p=0.001) was reported in 6 (25 %) patients in the warfarin group and 2 (1.5 %) in the non-warfarin group.
• In the warfarin group, mean length of stay was longer (1.23±0.46 days) as compared to non-warfarin (1.02±0.18 days) group (p=0.0008).
• The risk of hematoma was predicted by an INR > 1.8.
• No increase in the risk of hematoma was observed with concomitant use of dual antiplatelet therapy (DAPT).
• In addition, findings demonstrated that none of the patients with hematoma developed infection or required hematoma evacuation.