Warfarin prevents venous obstruction after cardiac devices implantation in high-risk patients: partial analysis.

Abstract

OBJECTIVES:

To evaluate the efficacy of prophylactic use of warfarin in patients with high risk of lead-associated thrombosis.

METHODS:

Clinical, prospective, randomized and blinded study, in patients submitted to first transvenous leads implantation with LVEF <0.40 and/or previous ipsilateral temporary pacing. After device implantation, patients were randomly assigned to placebo or warfarin. Periodical clinical and laboratorial evaluations were performed to anticoagulant management. After a six-month period, every patient was submitted to a digital subtraction venography. From February 2004 to November 2006, 101 patients underwent randomization. Baseline characteristics were similar in both groups (P=NS).

RESULTS:

Venographic analysis showed 31.4% of venous obstructions in patients assigned to warfarin as compared with 57.1% in patients assigned to placebo (RR= 0.57 [95% CI, 0.33 to 0.98]; P=0.015). In the warfarin group, 72% of the PT/INR tests were in therapeutic INR range. Only one patient required warfarin discontinuation and cross-over to placebo group due to gastrointestinal bleeding.

CONCLUSIONS:

These preliminary results showed that the anticoagulation therapy has been safe and reduced the frequency of venous thrombosis after transvenous cardiac devices implantation in high risk patients.

• Authors: Kátia Regina da Silva, Roberto Costa, Roberto Abi Rached, Martino Martinelli Filho, José Guilherme Mendes Pereira Caldas, Francisco César Carnevale, Luiz Felipe Pinho Moreira, Noedir Antonio Groppo Stolf
• Journal: Revista brasileira de cirurgia cardiovascular : orgao oficial da Sociedade Brasileira de Cirurgia Cardiovascular (Rev Bras Cir Cardiovasc) 2008 Oct-Dec Vol. 23 Issue 4 Pg. 542-9 Brazil
• PMID: 19229428 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Anticoagulants
• Warfarin

Topics

• Administration, Oral
• Anticoagulants (pharmacology)
• Cardiac Pacing, Artificial
• Epidemiologic Methods
• Female
• Humans
• International Normalized Ratio
• Male
• Middle Aged
• Pacemaker, Artificial
• Postoperative Complications (blood, prevention & control)
• Risk Assessment
• Venous Thrombosis (blood, prevention & control)
• Warfarin (pharmacology)