The Relationship between Warfarin, Aspirin, and Clopidogrel Continuation in the Peri-procedural Period and the Incidence of Hematoma Formation after Device Implantation

Thal, Sergio; Moukabary, Talal; Boyella, Ravichandra; Shanmugasundaram, Madhan; Pierce, Mary K.; Thai, Hoang; Goldman, Steven

doi:10.1111/j.1540-8159.2009.02674.x

Cited by 53 publications

(32 citation statements)

References 15 publications

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“…BRUISE CONTROL a multicenter randomized clinical trial has observed that bleeding complications are higher with heparin bridging strategy compared to continued oral anticoagulation (16% vs 3.5%, p < 0.001) [21]. Few studies have suggested increase in hematoma formation with antiplatelet agents [14], [29]. Other studies disagree with this evidence and suggest that this risk does not increase with antiplatelet agents [30], [31].…”

Section: Discussionmentioning

confidence: 99%

Incidence, predictors and outcomes of hematoma after ICD implantation: An analysis of a nationwide database of 85,276 patients

Sridhar

Yarlagadda

Kanmanthareddy

et al. 2016

Indian Pacing and Electrophysiology Journal

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BackgroundPocket hematoma is one of the most common complications following cardiac device implantation. This study examined the impact of this complication on in-hospital outcomes following Implantable Cardioverter Defibrillator (ICD) implantation.MethodsData from Nationwide Inpatient Sample (NIS) 2010 was queried to identify all primary implantations of ICDs and Cardiac Resynchronization Therapy Defibrillators (CRT-D) during the year 2010 using ICD-9 codes. We then identified the patients who experienced a procedure related hematoma during the hospital stay. We compared the outcomes of the patients with and without a hematoma complication. All analyses were performed using SPSS 20 complex samples using appropriate weights to adjust for the complex sampling design of the national database.ResultsOut of a total of 85,276 primary ICD implantations in the year 2010, 2233 (2.6% of the implantations) were complicated by a hematoma. Increased age (p < 0.001), and comorbidities such as congestive heart failure (odds ratio (OR) – 1.86, p < 0.001), coagulopathy (OR - 2.3, p < 0.001) and renal failure (OR - 1.52, p < 0.001) were associated with an increased risk of pocket hematoma formation. Patients who developed a hematoma had a longer hospitalization (9.1 days versus 5.5 days, p < 0.001) and higher in-hospital costs ($56,545 versus $47,015, p < 0.001) compared to patients who did not have a hematoma. Overall mortality associated with ICD implantation was low (0.6%), and hematoma formation did not adversely affect mortality (0.6% versus 0.4%, p = 0.63).ConclusionHematoma occurs infrequently after ICD implantation, however, it adversely impacts the cost of procedure and length of stay.

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Section: Discussionmentioning

confidence: 99%

Incidence, predictors and outcomes of hematoma after ICD implantation: An analysis of a nationwide database of 85,276 patients

Sridhar

Yarlagadda

Kanmanthareddy

et al. 2016

Indian Pacing and Electrophysiology Journal

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“…These findings are consistent with reports from other cardiovascular procedures where AC continuation did not increase bleeding risks compared with AC cessation, and were less prone to result in bleeding events compared HBS 28-34 . The concomitant use of AC and DAPT is less studied but has been associated with increased bleeding risk 8, 21 .…”

Section: Discussionmentioning

confidence: 99%

Meta-Analysis of Bleeding Complications Associated With Cardiac Rhythm Device Implantation

Bernard

Shotwell

Nietert

et al. 2012

Circ: Arrhythmia and Electrophysiology

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Background Many patients receiving cardiac rhythm devices have conditions requiring antiplatelet (AP) and/or anticoagulant (AC) therapy. Current guidelines recommend a heparin bridging strategy (HBS) for anticoagulated patients with moderate/high risk for thrombosis. Several studies reported lower bleeding risk with continued oral anticoagulation rather than HBS. The best strategy for perioperative management of patients on AP therapy is less clear. The present study was designed as a meta-analysis of device implantation associated bleeding complications using different AC/AP therapies. Methods and Results PubMed and Cochrane Database searches identified articles based on design, outcomes and available data. Device recipients were grouped as follows: no therapy (NT), aspirin only, AC held, AC continued, dual AP, HBS. The primary outcome was defined as a bleeding complication including hematoma, transfusion or prolonged hospital stay. Thirteen articles were identified for analysis including 5978 patients. The combined incidence of bleeding complications was 274/5978 (4.6%), ranging from 2.2% (NT) to 14.6% (HBS). The estimated odds of bleeding were increased by 8.3 (95% CI 5.5-12.9) times in the HBS group, 5.0 (95% CI 3.0-8.3) for dual AP therapy, 1.7 (95% CI 1.0-3.1) for AC held, 1.6 (95% CI 0.9-2.6) for AC continued, and 1.5 (95% CI 0.9-2.3) for aspirin only, relative to the NT group. HBS significantly increased bleeding events compared with holding or continuing AC. Continuing AC did not increase bleeding events compared with NT. Conclusions Continuing AC appears safer than HBS for device implantation. Dual AP therapy but not continuing AC carries a significant risk of bleeding.

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“…There are reasonable data to suggest that minor procedures such as tooth extractions, skin biopsies, pacemaker placement, and cataract removal do not require cessation of VKAs [101][102][103][104]. This information is not widely known and many surgeons refuse to perform such procedures while patients are on VKAs.…”

Section: Bridging With Heparinsmentioning

confidence: 92%

Stroke Prevention Treatment of Patients with Atrial Fibrillation: Old and New

Bal

Ojha

Hill

2010

Curr Neurol Neurosci Rep

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Atrial fibrillation is the most common cause of cardioembolic ischemic stroke and has a rising prevalence worldwide. Stroke prevention in this condition is poised to take a substantial leap forward with the evolution of new anticoagulant medications, with superior properties compared to vitamin K antagonists. New, safer and more effective chronic therapy is on the horizon. However, many issues surrounding the management of stroke prevention after an acute stroke and during the course of chronic anticoagulant therapy remain to be resolved.

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The Relationship between Warfarin, Aspirin, and Clopidogrel Continuation in the Peri-procedural Period and the Incidence of Hematoma Formation after Device Implantation

Cited by 53 publications

References 15 publications

Incidence, predictors and outcomes of hematoma after ICD implantation: An analysis of a nationwide database of 85,276 patients

Incidence, predictors and outcomes of hematoma after ICD implantation: An analysis of a nationwide database of 85,276 patients

Meta-Analysis of Bleeding Complications Associated With Cardiac Rhythm Device Implantation

Stroke Prevention Treatment of Patients with Atrial Fibrillation: Old and New

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