Chronic kidney disease is an independent predictor of pocket hematoma after pacemaker and defibrillator implantation

Ahmed, Imdad; Gertner, Elie; Nelson, W. Bradley; House, Chad M.; Zhu, Dennis W

doi:10.1007/s10840-010-9520-6

Cited by 10 publications

(10 citation statements)

References 19 publications

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“…Our study demonstrated similar numbers of CSH (incidence 1.2%) and non‐CSH (incidence 4.5%) when compared to the literature. In the literature, patients older than 75 years of age have an increased risk of hematoma formation, and two studies identified a strong female preponderance in hematoma formation . However, in our study, age and gender do not affect hematoma formation significantly.…”

Section: Discussioncontrasting

confidence: 79%

“…In the literature, patients older than 75 years of age have an increased risk of hematoma formation, 6 and two studies identified a strong female preponderance in hematoma formation. 5,7 However, in our study, age and gender do not affect hematoma formation significantly. Our finding of no cases of infection post-CIED implantation may be explained…”

Section: Discussioncontrasting

confidence: 73%

“…Previous studies have identified several possible risk factors for CIED hematoma. These include anticoagulation use, particularly with unfractionated and low‐molecular‐weight heparin, dual antiplatelet therapy, clopidogrel alone, chronic kidney disease (CKD), advanced age, and gender . Postprocedure heparinization has a profound effect on hematoma formation rates of up to 20% …”

Section: Introductionmentioning

confidence: 99%

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Cardiac implantable electronic device hematomas: Risk factors and effect of prophylactic pressure bandaging

Koh

Bingham

Law

et al. 2017

Pacing Clinical Electrophis

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Section: Discussioncontrasting

confidence: 79%

Section: Discussioncontrasting

confidence: 73%

Section: Introductionmentioning

confidence: 99%

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Cardiac implantable electronic device hematomas: Risk factors and effect of prophylactic pressure bandaging

Koh

Bingham

Law

et al. 2017

Pacing Clinical Electrophis

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“…We previously reported that chronic kidney disease was an independent risk factor for pocket hematoma after CIED implantation, probably due to a higher bleeding tendency in these patients [32]. A recent report from a prospective, multicenter registry confirmed that HAS-BLED score predicted bleedings during bridging of chronic oral anticoagulation [33].…”

Section: Empirical Approaches To Reduce the Perioperative Bleeding Comentioning

confidence: 93%

Perioperative management of anticoagulation in patients on warfarin therapy undergoing surgery for cardiac implantable electronic devices

Zhu

Ahmed

2013

Journal of Arrhythmia

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Many patients on chronic warfarin therapy are undergoing surgery for permanent pacemakers and implantable defibrillators, collectively known as cardiac implantable electronic device (CIED). The perioperative management of anticoagulation in these patients is a challenging clinical situation that requires balance between the risk of acute thrombosis and perioperative hemorrhage. This issue however, is inadequately addressed in the guidelines published by professional organizations. Increasing evidence suggests that temporarily interrupting anticoagulation is associated with a small but real thromboembolic risk, whereas cessation of warfarin with heparin bridging anticoagulation frequently leads to a higher incidence of pocket hematoma. Continuing warfarin with a therapeutic international normalized ratio appears to be a safe and cost‐effective approach for CIED surgery in most patients with moderate to high thromboembolic risk. An algorithm is proposed for the practical management of anticoagulation and antiplatelet therapy in these patients during the perioperative period.

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“…Results from recent retrospective and prospective studies cite a wide range of estimates for the incidence of bleeding complications, ranging from 1.1% to 16% 7, 8, 9, 10, 11, 12, 13. Once bleeding occurs, clinically meaningful pocket hematoma has been linked to a significant increase in perioperative pain and decrease in quality of life 9.…”

Section: Introductionmentioning

confidence: 99%

Incidence of Bleeding‐Related Complications During Primary Implantation and Replacement of Cardiac Implantable Electronic Devices

Nichols

Vose

2017

JAHA

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BackgroundUse of cardiac implantable electronic devices (CIEDs) is increasing. The incidence of bleeding‐related complications during CIED procedures and the association with subsequent infection risk have been studied in trial settings but not in nonrandomized “real‐world” populations.Methods and ResultsThis retrospective database analysis of US insurance claims from the Truven MarketScan database (2009‐2013) evaluated the incidence of bleeding complications during, or in the 30 days following, a CIED procedure and the association between bleeding and subsequent infection in days 31 to 365 of follow‐up. This study identified 42 606 patients who had a primary or replacement CIED procedure and met all inclusion criteria. Incidence of bleeding ranged from 0.58% to 2.81% by type of pharmaceutical therapy. Incidence of infection during days 31 to 365 of follow‐up was significantly higher among patients with a bleeding complication in the first 30 days versus those without (6.56% vs 1.24%, P<0.001), with results upheld in multivariate analysis (HR=2.97, 95% CI 1.94‐4.54, P<0.001).ConclusionsThis study provides a lower bound of the real‐world incidence of bleeding complications following a CIED procedure within the coding limitations of an insurance claims database. Results confirm the association between bleeding in the pocket and risk of subsequent infection. Further research is needed to precisely identify the costs associated with bleeding in the pocket.

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Chronic kidney disease is an independent predictor of pocket hematoma after pacemaker and defibrillator implantation

Abstract: Chronic kidney disease is a significant risk factor for pocket hematoma formation after pacemaker and ICD placement, independent of anticoagulation and antiplatelet agents.

Cited by 10 publications

References 19 publications

Cardiac implantable electronic device hematomas: Risk factors and effect of prophylactic pressure bandaging

Cardiac implantable electronic device hematomas: Risk factors and effect of prophylactic pressure bandaging

Perioperative management of anticoagulation in patients on warfarin therapy undergoing surgery for cardiac implantable electronic devices

Incidence of Bleeding‐Related Complications During Primary Implantation and Replacement of Cardiac Implantable Electronic Devices

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