{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T23:41:51Z","timestamp":1793144511252,"version":"4.5.0"},"reference-count":28,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"10","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Arrhythmia and Electrophysiology"],"published-print":{"date-parts":[[2019,10]]},"abstract":"<jats:sec>\n            <jats:title>Background:<\/jats:title>\n            <jats:p>Oral anticoagulant use is common among patients undergoing pacemaker or defibrillator surgery. BRUISE CONTROL (Bridge or Continue Coumadin for Device Surgery Randomized Controlled Trial; NCT00800137) demonstrated that perioperative warfarin continuation reduced clinically significant hematomas (CSH) by 80% compared with heparin bridging (3.5% versus 16%). BRUISE-CONTROL-2 (NCT01675076) observed a similarly low risk of CSH when comparing continued versus interrupted direct oral anticoagulant (2.1% in both groups). Using patient level data from both trials, the current study aims to: (1) evaluate the effect of concomitant antiplatelet therapy on CSH, and (2) understand the relative risk of CSH in patients treated with direct oral anticoagulant versus continued warfarin.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods:<\/jats:title>\n            <jats:p>We analyzed 1343 patients included in BRUISE-CONTROL-1 and BRUISE-CONTROL-2. The primary outcome for both trials was CSH. There were 408 patients identified as having continued either a single or dual antiplatelet agent at the time of device surgery.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results:<\/jats:title>\n            <jats:p>\n              Antiplatelet use (versus nonuse) was associated with CSH in 9.8% versus 4.3% of patients (\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001), and remained a strong independent predictor after multivariable adjustment (odds ratio, 1.965; 95% CI, 1.202\u20133.213;\n              <jats:italic>P<\/jats:italic>\n              =0.0071). In multivariable analysis, adjusting for antiplatelet use, there was no significant difference in CSH observed between direct oral anticoagulant use compared with continued warfarin (odds ratio, 0.858; 95% CI, 0.375\u20131.963;\n              <jats:italic>P<\/jats:italic>\n              =0.717).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions:<\/jats:title>\n            <jats:p>Concomitant antiplatelet therapy doubled the risk of CSH during device surgery. No difference in CSH was found between direct oral anticoagulant versus continued warfarin. In anticoagulated patients undergoing elective or semi-urgent device surgery, the patient specific benefit\/risk of holding an antiplatelet should be carefully considered.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Clinical Trial Registration:<\/jats:title>\n            <jats:p>\n              URL:\n              <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.clinicaltrials.gov\">https:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n              . Unique identifiers: NCT00800137, NCT01675076.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circep.119.007545","type":"journal-article","created":{"date-parts":[[2019,10,15]],"date-time":"2019-10-15T09:00:32Z","timestamp":1571130032000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":32,"title":["Effect of Direct Oral Anticoagulants, Warfarin, and Antiplatelet Agents on Risk of Device Pocket Hematoma"],"prefix":"10.1161","volume":"12","author":[{"given":"Vidal","family":"Essebag","sequence":"first","affiliation":[{"name":"McGill University, McGill University Health Centre and H\u00f4pital Sacr\u00e9-Coeur de Montr\u00e9al, QC, Canada (V.E.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeff S.","family":"Healey","sequence":"additional","affiliation":[{"name":"McMaster University, Hamilton Health Sciences, Population Health Research Institute, Hamilton, ON, Canada (J.S.H., J.E.,)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacqueline","family":"Joza","sequence":"additional","affiliation":[{"name":"McGill University, McGill University Health Centre, Montreal, QC, Canada (J.J.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pablo B.","family":"Nery","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Ottawa, University of Ottawa Heart Institute, ON, Canada (P.B.N., G.A.W., D.H.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eli","family":"Kalfon","sequence":"additional","affiliation":[{"name":"Galilee Medical Centre, Naharyia, Israel (E.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tiago L.L.","family":"Leiria","sequence":"additional","affiliation":[{"name":"Instituto de Cardiologia, Fundacao Universidade de Cardiologia, Porte Alegre, RS, Brazil (T.L.L.L)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Atul","family":"Verma","sequence":"additional","affiliation":[{"name":"Southlake Regional Health Centre, Newmarket, ON, Canada (A.V.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felix","family":"Ayala-Paredes","sequence":"additional","affiliation":[{"name":"Universit\u00e9 de Sherbrooke, Hopital Fleurimont (F.A.-P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benoit","family":"Coutu","sequence":"additional","affiliation":[{"name":"Centre Hospitalier de L'Universit\u00e9 de Montreal, Hopital Hotel-Dieu, QC, Canada (B.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Glen L.","family":"Sumner","sequence":"additional","affiliation":[{"name":"University of Calgary, Libin Cardiovascular Institute, Foothills Medical Centre, AB, Canada (G.L.S., K.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuliano","family":"Becker","sequence":"additional","affiliation":[{"name":"H\u00f4pital du Sacr\u00e9-Coeur de Montr\u00e9al, QC, Canada (G.B., M.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fran\u00e7ois","family":"Philippon","sequence":"additional","affiliation":[{"name":"Laval University, Quebec Heart Institute, Quebec City, Canada (F.P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Eikelboom","sequence":"additional","affiliation":[{"name":"McMaster University, Hamilton Health Sciences, Population Health Research Institute, Hamilton, ON, Canada (J.S.H., J.E.,)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roopinder K.","family":"Sandhu","sequence":"additional","affiliation":[{"name":"University of Alberta, Edmonton, Canada (R.K.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Sapp","sequence":"additional","affiliation":[{"name":"Dalhousie University, QEII Health Sciences Centre, Halifax, NS, Canada (J.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Leather","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of British Columbia, Vancouver, Canada (R.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Derek","family":"Yung","sequence":"additional","affiliation":[{"name":"Scarborough Health Network, University of Toronto, Clinical Adjunct, ON, Canada (D.Y.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernard","family":"Thibault","sequence":"additional","affiliation":[{"name":"Montreal Heart Institute, Universit\u00e9 de Montreal, QC, Canada (B.T.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher S.","family":"Simpson","sequence":"additional","affiliation":[{"name":"Heart Rhythm Service, Queen's University, Kingston ON, Canada (C.S.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kamran","family":"Ahmad","sequence":"additional","affiliation":[{"name":"University of Toronto, St Michael's Hospital, ON, Canada (K.A.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Satish","family":"Toal","sequence":"additional","affiliation":[{"name":"Saint John Regional Hospital, NB, Canada (S.T.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcio","family":"Sturmer","sequence":"additional","affiliation":[{"name":"H\u00f4pital du Sacr\u00e9-Coeur de Montr\u00e9al, QC, Canada (G.B., M.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine","family":"Kavanagh","sequence":"additional","affiliation":[{"name":"University of Calgary, Libin Cardiovascular Institute, Foothills Medical Centre, AB, Canada (G.L.S., K.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eugene","family":"Crystal","sequence":"additional","affiliation":[{"name":"Arrhythmia Services, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, ON, Canada (E.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George A.","family":"Wells","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Ottawa, University of Ottawa Heart Institute, ON, Canada (P.B.N., G.A.W., D.H.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew D.","family":"Krahn","sequence":"additional","affiliation":[{"name":"University of British Columbia, Vancouver, Canada (A.D.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David H.","family":"Birnie","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Ottawa, University of Ottawa Heart Institute, ON, Canada (P.B.N., G.A.W., D.H.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"for the BRUISE CONTROL Investigators*","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1302946"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2009.12.056"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1540-8159.2011.03049.x"},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2011.10.010"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/euv075"},{"key":"e_1_3_4_7_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10096-012-1655-1"},{"key":"e_1_3_4_8_2","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/euv190"},{"key":"e_1_3_4_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2016.01.009"},{"key":"e_1_3_4_10_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.106.678664"},{"key":"e_1_3_4_11_2","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/eus337"},{"key":"e_1_3_4_12_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.113.000763"},{"key":"e_1_3_4_13_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehp421"},{"key":"e_1_3_4_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2015.02.035"},{"key":"e_1_3_4_15_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1540-8159.2009.02569.x"},{"key":"e_1_3_4_16_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.113.006027"},{"key":"e_1_3_4_17_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehy413"},{"key":"e_1_3_4_18_2","doi-asserted-by":"publisher","DOI":"10.1378\/chest.126.4.1177"},{"key":"e_1_3_4_19_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCEP.109.917625"},{"key":"e_1_3_4_20_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCEP.111.969105"},{"key":"e_1_3_4_21_2","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/euw116"},{"key":"e_1_3_4_22_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2017.03.057"},{"key":"e_1_3_4_23_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1611594"},{"key":"e_1_3_4_24_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.110.959205"},{"key":"e_1_3_4_25_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12872-016-0251-1"},{"key":"e_1_3_4_26_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2019.04.066"},{"key":"e_1_3_4_27_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra071014"},{"key":"e_1_3_4_28_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehx419"},{"key":"e_1_3_4_29_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2016.03.513"}],"container-title":["Circulation: Arrhythmia and Electrophysiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/CIRCEP.119.007545","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T00:02:22Z","timestamp":1715558542000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCEP.119.007545"}},"subtitle":["Combined Analysis of BRUISE CONTROL 1 and 2"],"short-title":[],"issued":{"date-parts":[[2019,10]]},"references-count":28,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2019,10]]}},"alternative-id":["10.1161\/CIRCEP.119.007545"],"URL":"https:\/\/doi.org\/10.1161\/circep.119.007545","relation":{},"ISSN":["1941-3149","1941-3084"],"issn-type":[{"value":"1941-3149","type":"print"},{"value":"1941-3084","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,10]]},"assertion":[{"value":"2019-03-06","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-08-07","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-10-15","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e007545"}}