Contemporary Management of Antiplatelet and Anticoagulation for Cardiac Implantable Device Procedures.

The use of oral anticoagulation and antiplatelet therapy is common among patients undergoing placement of pacemakers or defibrillators. This comes as no surprise as patients requiring cardiac implantable electronic devices (CIEDs) are older and more often have comorbidities such as atrial fibrillation, ischemic cardiomyopathy, or both. Continuation of anticoagulation confers stroke prophylaxis, whereas antiplatelet continuation is necessary in those with recent stent placement. In patients with high stroke risk, heparin bridging can be used in the perioperative setting. The concern that comes to fruition at the time of CIED implantation is the risk of not achieving adequate hemostasis intraprocedurally, as well as the risk of postimplant device pocket hematoma (DPH). DPH is fraught with several issues including patient comorbidities such as pain/discomfort, need for pocket reintervention for hematoma evacuation, increased infection risk, and significant costs associated with length of hospitalization and additional procedures.1–3