Korean Circ J.  2012 Aug;42(8):538-542. 10.4070/kcj.2012.42.8.538.

Antithrombotic or Anti-Platelet Agents in Patients Undergoing Permanent Pacemaker Implantation

• Lee CK
• Yoo SY
• Hong MY
• Jang JK

• KMID: 2225003
• DOI: http://doi.org/10.4070/kcj.2012.42.8.538

Abstract

BACKGROUND AND OBJECTIVES
The growing implantations of electrophysiological devices in the context of increasing rates of chronic antithrombotic therapy in cardiovascular disease patients underscore the importance of an effective periprocedural prophylactic strategy for prevention of bleeding complications. We assessed the risk of significant bleeding complications in patients receiving anti-platelet agents or anticoagulants at the time of permanent pacemaker (PPM) implantation.
SUBJECTS AND METHODS
We reviewed bleeding complications in patients undergoing PPM implantation. The use of aspirin or clopidogrel was defined as having taking drugs within 5 days of the procedure and warfarin was changed to heparin before the procedure. A significant bleeding complication was defined as a bleeding incident requiring pocket exploration or blood transfusion.
RESULTS
Permanent pacemaker implantations were performed in 164 men and 96 women. The mean patient age was 73+/-11 years old. Among the 260 patients, 14 patients took warfarin (in all of them, warfarin was changed to heparin at least 3 days before procedure), 54 patients took aspirin, 4 patients took clopidogrel, and 25 patients took both. Significant bleeding complications occurred in 8 patients (3.1%), all of them were patients with heparin bridging (p<0.0001). Heparin bridging markedly increased the length of required hospital stay when compare with other groups and the 4 patients (1.5%) that underwent the pocket revision for treatment of hematoma.
CONCLUSION
This study suggests that hematoma formation after PPM implantation was rare, even among those who had taken the anti-platelet agents. The significant bleeding complications frequently occurred in patients with heparin bridging therapy. Therefore, heparin bridging therapy was deemed as high risk for significant bleeding complication in PPM implantation.

Keyword

Aspirin; Clopidogrel; Warfarin; Hematoma

MeSH Terms

Anticoagulants
Aspirin
Cardiovascular Diseases
Female
Hematoma
Hemorrhage
Heparin
Humans
Length of Stay
Male
Ticlopidine
Warfarin
Anticoagulants
Aspirin
Heparin
Ticlopidine
Warfarin

Figure

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  Fig. 1 Distribution of patients between groups. Group 1: none, Group 2: aspirin or clopidogrel, Group 3: dual antiplatelet agents, Group 4: temporary interruption of warfarin with switching to unfractionated heparin in periprocedural period.

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  Fig. 2 Hospital stay between groups.

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