Perioperative management of antithrombotic therapy in patients receiving cardiovascular implantable electronic devices: a network meta-analysis
- 25.08.2017
- MULTIMEDIA REPORT
Erschienen in:
- Verfasst von
- Hua He
- Bing-Bing Ke
- Yan Li
- Fu-Sheng Han
- Xiaodong Li
- Yu-Jie Zeng
- Erschienen in
- Journal of Interventional Cardiac Electrophysiology | Ausgabe 1/2017
Abstract
Purpose
Network meta-analysis (NMA) has advantages including being able to simultaneously compare and rank multiple treatments over traditional meta-analysis. We evaluated by a NMA the optimal antithrombotic strategy during the perioperative period of implantation of cardiovascular implantable electronic devices (CIEDs).
Methods
We performed a network meta-analysis of observational studies (cohort and case-control studies). The eligible studies tested the following antithrombotic therapy during the CIED placement: aspirin, clopidogrel, warfarin, novel oral anticoagulants (NOACs), and heparin bridging.
Results
Thirty-one observational studies with 119 study arms were included (41,174 patients receiving long-term antithrombotic therapy; median age, 72.6 years; 70.1% males; median follow-up, 3.6 years). Aspirin (4.26 [2.88–7.22]), warfarin (3.37 [2.17–5.23]), and clopidogrel (3.30 [1.49–5.88]) reduced the risk of bleeding as compared with heparin bridging, and there was no significance difference between continued NOACs and heparin bridging (0.67 [0.21–2.18]). The comparison of commonly used protocols in the management of anticoagulant therapy revealed that continued warfarin (0.38 [0.20–0.74]), continued NOACs (0.19 [0.04–0.89]), and heparin bridging therapy (0.01 [0.05–0.21]) increased the risk of bleeding as compared that of control, and continued warfarin (3.74 [1.96–7.16]), interrupted warfarin (4.89 [2.20–10.88]), and interrupted NOACs (12.5 [1.25–100]) reduced the risk of bleeding compared with that of heparin bridging.
Conclusions
Among various antithrombotic drugs, aspirin had the lowest bleeding risk, followed by warfarin, clopidogrel and NOACs, and heparin, with the greatest bleeding risk. NOACs therapy appears safe and effective, and interrupted NOACs may be the optimal anticoagulation protocol for use during the perioperative period of CIED implantation.
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- Titel
- Perioperative management of antithrombotic therapy in patients receiving cardiovascular implantable electronic devices: a network meta-analysis
- Verfasst von
-
Hua He
Bing-Bing Ke
Yan Li
Fu-Sheng Han
Xiaodong Li
Yu-Jie Zeng
- Publikationsdatum
- 25.08.2017
- Verlag
- Springer US
- Erschienen in
-
Journal of Interventional Cardiac Electrophysiology / Ausgabe 1/2017
Print ISSN: 1383-875X
Elektronische ISSN: 1572-8595 - DOI
- https://doi.org/10.1007/s10840-017-0280-4
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