查看文章

Introduction: The incidence of venous thrombosis after cardiac devices implantation is high. Ventricular dysfunction and previous transvenous temporary leads ipsilaterally to the permanent implantation are independent risk factors. The effect of prophylactic strategies to prevent these complications remains controversial.

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

Method: 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.

Results: From Feb/2004 to Nov/2006, 101 patients underwent randomization. Baseline characteristics were similar in both groups (P= NS). 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 anticoagulation therapy has been safe and reduced the frequency of venous thrombosis after transvenous cardiac devices implantation in high risk patients.

Descriptors: Cardiac Pacing, artificial …