A 60-Year-Old Patient Receives an AICD After a Cardiac Arrest Episode

A 60-year-old man with past medical history of hypertension, coronary artery disease (CAD), congestive heart failure (CHF) with left ventricular ejection fraction (LVEF) of 25%, history of recurrent deep vein thrombosis (DVT) on chronic oral anticoagulation and atrial fibrillation (AF) was admitted for exacerbation of CHF. During hospitalization he had an episode of cardiac arrest. It was decided to place an automatic implantable cardioverter defibrillator (AICD) for secondary prevention.

Past medical history: Coronary artery disease, congestive heart failure, recurrent DVT, atrial fibrillation

Current medications: Aspirin, Simvastatin, Warfarin, Carvedilol

Physical exam:
General: Alert
Neck: Elevated Jugular venous pressure
Cardiac: irregularly irregular heart rate, S1, S2 heard
Chest: minimal crackles at the bases of the lungs
Extremities: 1+ pedal edema

What would be an appropriate strategy for management of periprocedural anticoagulation during placement of the AICD device so as to balance the risk of bleeding and thromboembolic complications?

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