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

Abstract

Background and ObjectivesThe 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 MethodsWe 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.ResultsPermanent 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.ConclusionThis 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.

Early Pacemaker Implantation after Transcatheter Aortic Valve Replacement: Impact of PlasmaBlade™ for Prevention of Device-Associated Bleeding Complications

“…However, it is associated with an increased risk of bleeding with a prevalence of up to 20% for device-pocket hematoma versus 2-4% in patients in whom warfarin was persistently used [17,19,20,25,39]. In some studies, heparin-bridging therapy was reported to pose an even higher risk than DAPT [40]; therefore, the continuation of warfarin therapy during PPI has been favored [39], but this is not possible during TAVR. Continuous multiple anticoagulation therapies are possible, but patients with high HAS-BLED scores or valvular heart disease require careful attention during PPI [41].…”

“…However, device-pocket hematoma undoubtedly is an inconvenient complication associated with pain, especially in elderly patients at high risk owing to a prolonged recovery, which leads to pocket infections and wound dehiscence. Furthermore, intraoperative bleeding is related to prolonged procedure time, the increased risk of infection, and prolongation of hospitalization and treatment costs [40].…”

Synchronizing Beats: From Theory to Advances and Insight in Cardiac Resynchronization Therapy

“…Close monitoring post-CRT implantation is essential due to potential changes in urine output and electrolyte balance, which may necessitate modifications to the prescribed drugs [110]. Temporarily withdrawing antiplatelet agents before implantation may decrease bleeding risk [111]. Perioperative antibiotic administration has been shown to significantly reduce infection rates [110].…”