Is Antiarrhythmia Device Implantation Safe Under Dual Antiplatelet Therapy?

Dreger, Henryk; Grohmann, Andrea; Bondke, Hansjürgen; Gast, B. De; Baumann, Gert; Melzer, Christoph

doi:10.1111/j.1540-8159.2009.02645.x

Cited by 25 publications

(19 citation statements)

References 17 publications

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“…DAPT therapy prevents stent thrombosis which is a devastating complication with a high mortality. On the contrary, Dreger et al17) did not demonstrate increased bleeding complications in DAPT therapy patients but in this study a vacuum drainage system was applied to all patients. Tompkins et al19) reported dual DAPT and periprocedural heparin significantly increased the risk of bleeding complications at the time of pacemaker or ICD implantation.…”

Section: Discussioncontrasting

confidence: 57%

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

et al. 2012

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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.

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Section: Discussioncontrasting

confidence: 57%

“…Regarding DAPT therapy the reported bleeding risk varies between 0.7 and 24% 16)17). This great variability is due to differences in the definition of bleeding complications, and patient and procedural disparities.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2012

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“…When planning implantation of pacemaker in these patients, it should be noted that dual-antiplatelet therapy is usually required after PCI in the era of drug-eluting stent 15). On the other hand, dual-antiplatelet therapy at the time of pacemaker implantation might increase the risk of bleeding complication and extend procedure time 16-18). Considering this clinical aspect and our study results, we recommend application of different therapeutic strategies for each entity (Fig.…”

Section: Discussionmentioning

confidence: 84%

Reversibility of Atrioventricular Block According to Coronary Artery Disease: Results of a Retrospective Study

Hwang

Seo

et al. 2012

Korean Circ J

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Background and ObjectivesThe causal relationship of clinically-significant atrioventricular block (AVB) and coronary artery disease (CAD) is uncertain. We investigated whether CAD is related to irreversible AVB that requires treatment with a permanent pacemaker.Subjects and MethodsWe included 188 consecutive patients with new-onset AVB considering pacemaker, who had undergone invasive or noninvasive coronary evaluation. Patients were divided into one of 2 groups: irreversible AVB who underwent implantation of permanent pacemaker {irreversible block (IB) group, n=173} or reversible AVB {reversible block (RB) group, n=15}.ResultsIn IB group, significant CAD was observed in 44 patients (25.4%) and there were 2 (1.2%) patients with acute myocardial infarction (AMI). In RB group, 14 patients (93.3%) had CAD (p<0.001) and 13 patients (86.7%) presented with AMI (p<0.001). On the aspect of CAD type and reversibility of AVB, 13/15 (86.7%) patients of AMI, 0/2 (0%) of unstable angina, and 1/41 (2.4%) of stable angina had reversible AVB.ConclusionAVB in patients with AMI is usually reversible. Therefore, permanent pacemaker implantation should be delayed in cases of AMI. AVB in patients with CAD other than AMI is usually irreversible.

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“…Pocket hematoma is a frequent complication in the early stages following cardiac device implantation and its incidence has been reported to be 0.9–22% [11–16,18–22]. In this study, 161 patients underwent cardiac device surgery and 10 (6.2%) of these patients had bleeding complications.…”

Section: Discussionmentioning

confidence: 70%

“Heparin bridging” increases the risk of bleeding complications in patients undergoing anticoagulation therapy and device implantation

Fujiwara

Yoshida

Takei

et al. 2012

Journal of Arrhythmia

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a b s t r a c tBackground: The purpose of this study is to evaluate the rate of perioperative bleeding complications following anticoagulation therapy in patients undergoing implantable electronic device implantation. Methods and results: We retrospectively analyzed the data from 161 consecutive patients with new device implants or generator replacement performed between February 2008 and June 2009 in our hospital. Sixty-five (40.3%) patients took warfarin, 55 (34.2%) took antiplatelet therapy, and 16 (9.9%) took dual antiplatelet therapy prior to implantation. Heparin bridging was performed in 7 of 65 patients taking warfarin. Pocket hematoma was observed in 10 (6.2%) patients and device infection was observed in 1 (0.6%) patient. No cases of thromboembolism were observed. There were no complications associated with warfarin (P¼ 0.19) or antiplatelet therapy (P¼ 0.69). However, the patients that had undergone heparin bridging were significantly more likely to have complications (3 of 10) (P¼0.005). In multivariate analysis, heparin bridging was the only independent predictor of complications. Conclusion: Our study suggests that heparin bridging increases the risk of perioperative bleeding complications in cardiac device implantation.

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Is Antiarrhythmia Device Implantation Safe Under Dual Antiplatelet Therapy?

Abstract: When drainage systems are used, antiarrhythmia device implantation is safe and can be performed without significantly increased risk of clinically relevant hematoma in patients on continued DA-therapy. (PACE 2010; 394-399).

Cited by 25 publications

References 17 publications

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

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

Reversibility of Atrioventricular Block According to Coronary Artery Disease: Results of a Retrospective Study

“Heparin bridging” increases the risk of bleeding complications in patients undergoing anticoagulation therapy and device implantation

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