Heparin Bridging or Continuation of Oral Anticoagulation for Transvenous Lead Extraction?

Objectives: Recent studies have shown that pacemaker and ICD implantation with continued warfarin therapy are associated with lower risk for bleeding complications, when compared with heparin bridging. However, no data are available for lead extraction in patients with oral anticoagulation. We therefore compared the bleeding risk with continued phenprocoumon therapy versus heparin bridging in patients receiving transvenous lead extraction.

Methods: Between 2012 and 2018, 187 patients received transvenous lead extraction with either laser- or mechanical extraction sheaths, including 89 patients with oral anticoagulation therapy. Fifty-four patients received lead extraction under continued phenprocoumon therapy, while 35 patients received heparin bridging for the extraction procedure. Patient’s data were prospectively collected into a database and analyzed. The primary outcome of the study was clinically significant bleeding or device pocket hematoma with need for surgical revision.

Results: Mean patients age was 68.2 years, 69% were male. In patients with heparin bridging therapy, preoperative INR prior to lead extraction was 1.5 ± 0.6, while in group of patients on continued phenprocoumon therapy, mean preoperative INR was 2.4 ± 0.6. Procedural success rate for complete lead removal was 98.1 versus 96.3% in phenprocoumon and heparin bridging group, respectively (p = 0.40). In heparin bridging group, three patients (9.4%) experienced a clinically relevant pocket hematoma, while one patient (1.8%) on continued phenprocoumon therapy needed surgical revision for pocket hematoma (p = 0.29). No further bleeding complications or clinically relevant pericardial effusion was observed in any of the groups and no perioperative stroke occurred.

Conclusion: Transvenous lead extraction with continued phenprocoumon therapy was safe and feasible without higher incidence of clinically relevant bleeding. Therefore, there is no necessity for heparin bridging strategies in patients undergoing transvenous lead extraction.