Thrombocytopenia, dual antiplatelet therapy, and heparin bridging strategy increase pocket hematoma complications in patients undergoing cardiac rhythm device implantation

Huang Chung Chen, Yung Lung Chen, Bih Fang Guo, Tzu Hsien Tsai, Jen Ping Chang, Kuo Li Pan, Yu Sheng Lin, Mien Cheng Chen*

*Corresponding author for this work

Research output: Contribution to journalJournal Article peer-review

14 Scopus citations

Abstract

Background: Pocket hematoma is a troublesome complication associated with the implantation of cardiac implantable electronic devices (CIEDs). This study aims to determinate the risk factors of pocket hematoma complications in relation to different antithrombotic strategies and severity of thrombocytopenia in Chinese patients. Methods: We conducted a retrospective study of 1093 consecutive patients undergoing implantation of CIEDs and divided them into 3 groups: no antithrombotic group (n= 512), continuing antiplatelet group (n= 477), and temporarily discontinuing warfarin with or without heparin bridging strategy (n= 104). Results: A pocket hematoma developed in 40 patients (3.7%). The temporarily discontinuing warfarin group (7.7%) had a higher incidence of pocket hematoma than no oral antithrombotic group (2.1%) and continuing antiplatelet group (4.4%) (P= 0.012). The dual antiplatelet group (16.2%) and the heparin bridging strategy group (14.0%) had significantly higher incidence of pocket hematoma compared with the no antithrombotic group (2.1%; P < 0.001, both). Patients having aspirin or clopidogrel alone had low incidence of pocket hematoma (3.9% and 1.2%, respectively), similar to the no antithrombotic group (P= not significant). Multivariate analysis revealed that dual antiplatelet agents (P= 0.004), heparin bridging strategy (P < 0.001), and moderate to severe thrombocytopenia (P= 0.007) were independent predictors for pocket hematoma complications. Conclusions: The use of dual antiplatelet agents, heparin bridging strategy, and the presence of moderate to severe thrombocytopenia significantly increased the risk of pocket hematoma complications in the periprocedural period of CIED implant. Aspirin or clopidogrel alone did not increase the risk of pocket hematoma complications.

Original languageEnglish
Pages (from-to)1110-1117
Number of pages8
JournalCanadian Journal of Cardiology
Volume29
Issue number9
DOIs
StatePublished - 09 2013

Fingerprint

Dive into the research topics of 'Thrombocytopenia, dual antiplatelet therapy, and heparin bridging strategy increase pocket hematoma complications in patients undergoing cardiac rhythm device implantation'. Together they form a unique fingerprint.

Cite this