1
|
Franczyk B, Rysz J, Olszewski R, Gluba-Sagr A. Do Implantable Cardioverter-Defibrillators Prevent Sudden Cardiac Death in End-Stage Renal Disease Patients on Dialysis? J Clin Med 2024; 13:1176. [PMID: 38398488 PMCID: PMC10889557 DOI: 10.3390/jcm13041176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 01/23/2024] [Accepted: 02/08/2024] [Indexed: 02/25/2024] Open
Abstract
Chronic kidney disease patients appear to be predisposed to heart rhythm disorders, including atrial fibrillation/atrial flutter, ventricular arrhythmias, and supraventricular tachycardias, which increase the risk of sudden cardiac death. The pathophysiological factors underlying arrhythmia and sudden cardiac death in patients with end-stage renal disease are unique and include timing and frequency of dialysis and dialysate composition, vulnerable myocardium, and acute proarrhythmic factors triggering asystole. The high incidence of sudden cardiac deaths suggests that this population could benefit from implantable cardioverter-defibrillator therapy. The introduction of implantable cardioverter-defibrillators significantly decreased the rate of all-cause mortality; however, the benefits of this therapy among patients with chronic kidney disease remain controversial since the studies provide conflicting results. Electrolyte imbalances in haemodialysis patients may result in ineffective shock therapy or the appearance of non-shockable underlying arrhythmic sudden cardiac death. Moreover, the implantation of such devices is associated with a risk of infections and central venous stenosis. Therefore, in the population of patients with heart failure and severe renal impairment, periprocedural risk and life expectancy must be considered when deciding on potential device implantation. Harmonised management of rhythm disorders and renal disease can potentially minimise risks and improve patients' outcomes and prognosis.
Collapse
Affiliation(s)
- Beata Franczyk
- Department of Nephrology, Hypertension and Family Medicine, Medical University of Lodz, 90-419 Lodz, Poland; (B.F.); (J.R.)
| | - Jacek Rysz
- Department of Nephrology, Hypertension and Family Medicine, Medical University of Lodz, 90-419 Lodz, Poland; (B.F.); (J.R.)
| | - Robert Olszewski
- Department of Gerontology, Public Health and Didactics, National Institute of Geriatrics, Rheumatology and Rehabilitation, 02-637 Warsaw, Poland;
| | - Anna Gluba-Sagr
- Department of Nephrology, Hypertension and Family Medicine, Medical University of Lodz, 90-419 Lodz, Poland; (B.F.); (J.R.)
| |
Collapse
|
2
|
Zheng J, Tu XM, Gao ZY. Successful transcatheter arterial embolization treatment for chest wall haematoma following permanent pacemaker implantation: A case report. World J Clin Cases 2022; 10:11877-11881. [PMID: 36405272 PMCID: PMC9669860 DOI: 10.12998/wjcc.v10.i32.11877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 09/13/2022] [Accepted: 10/17/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Haematoma is one of the main complications associated with pacemaker implantation. Pseudoaneurysm is a rare condition that is not easy to identify and is often overlooked.
CASE SUMMARY A female patient diagnosed with high-grade atrioventricular block underwent permanent pacemaker implantation. During the operation, puncturing a small branch of the right subclavian artery developed into a pseudoaneurysm and resulted in further haematoma formation. Conventional treatment of compression haemostasis and haemostatic drugs was not effective. A series of timely transcatheter arterial embolizations avoided serious complications.
CONCLUSION More possible conditions should be taken into consideration as haematoma is discovered, and timely treatment might prevent severe adverse events.
Collapse
Affiliation(s)
- Jing Zheng
- Department of Cardiology, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People’s Hospital, Quzhou 324000, Zhejiang Province, China
| | - Xiao-Ming Tu
- Department of Cardiology, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People’s Hospital, Quzhou 324000, Zhejiang Province, China
| | - Zhen-Yan Gao
- Department of Cardiology, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People’s Hospital, Quzhou 324000, Zhejiang Province, China
| |
Collapse
|
3
|
Ajibawo T, Okunowo O, Okunade A. Impact of Comorbidity Burden on Cardiac Implantable Electronic Devices Outcomes. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2022; 16:11795468221108212. [PMID: 35783108 PMCID: PMC9247999 DOI: 10.1177/11795468221108212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 05/12/2022] [Indexed: 11/26/2022]
Abstract
Background: There is limited data on the impact of comorbidity burden on clinical
outcomes of patients undergoing cardiac implantable electronic devices
(CIED) implantation. Objectives: Our aim was to assess trends in CIED implantations and explore the
relationship between comorbidity burden and outcomes in patients undergoing
de novo implantations. Methods: Using the National Inpatient Sample database from 2000 to 2014, we identified
adults ⩾18 years undergoing de novo CIED procedures. Comorbidity burden was
assessed by Charlson comorbidity Index (CCI), and patients were classified
into 4 categories based on their CCI scores (CCI = 0, CCI = 1, CCI = 2, CCI
⩾3). Annual implantation trends were evaluated. Logistic regression was
conducted to measure the association between categorized comorbidity burden
and outcomes. Results: A total of 3 103 796 de-novo CIED discharge records were identified from the
NIS database. About 22.4% had a CCI score of 0, 28.2% had a CCI score of 1,
22% had a CCI score of 2, and 27.4 % had a CCI score ⩾3. Annual de-novo CIED
implantations peaked in 2006 and declined steadily from 2010 to 2014.
Compared to CCI 0, CCI ⩾3 was independently associated with increased odds
of in-hospital mortality, bleeding, pericardial, and cardiac complications
(all P < .05). Length of stay and hospital charges
increased with increasing comorbidity burden. Conclusions: CCI is a significant predictor of adverse outcomes after CIED implantation.
Therefore, comorbidity burden needs to be considered in the decision-making
process for CIED implant candidates.
Collapse
Affiliation(s)
- Temitope Ajibawo
- Department of Internal Medicine, Banner University Medical Center, Phoenix, AZ, USA
| | - Oluwatimilehin Okunowo
- Data Science & Biostatistics Unit, Department of Biomedical and Health Informatics, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Adeniyi Okunade
- Department of Medicine, Brookdale University Medical Center, Brooklyn, NY, USA
| |
Collapse
|
4
|
Fei YP, Wang L, Zhu CY, Sun JC, Hu HL, Zhai CL, He CJ. Effect of a Novel Pocket Compression Device on Hematomas Following Cardiac Electronic Device Implantation in Patients Receiving Direct Oral Anticoagulants. Front Cardiovasc Med 2022; 9:817453. [PMID: 35282349 PMCID: PMC8907568 DOI: 10.3389/fcvm.2022.817453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 02/02/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundA pocket hematoma is a well-recognized complication that occurs after pacemaker or defibrillator implantation. It is associated with increased pocket infection and hospital stay. Patients suffering from atrial fibrillation and undergoing cardiovascular electronic implantable device (CIED) surgery are widely prescribed and treated with direct oral anticoagulants (DOACs). In this study, the use of a novel compression device was evaluated to examine its ability to decrease the incidence of pocket hematomas following device implantation with uninterrupted DOACs.MethodsA total of 204 participants who received DOACs and underwent CIED implantation were randomized into an experimental group (novel compression device) and a control group (elastic adhesive tape with a sandbag). The primary outcome was pocket hematoma, and the secondary outcomes were skin erosions and patient comfort score. Grade 3 hematoma was defined as a hematoma that required anticoagulation therapy interruption, re-operation, or prolonged hospital stay.ResultsThe baseline characteristics of both groups had no significant differences. The incidence of grades 1 and 2 hematomas was significantly lower in the compression device group than in the conventional pressure dressing group (7.8 vs. 23.5 and 2.0 vs. 5.9%, respectively; P < 0.01). Grade 3 hematoma occurred in 2 of 102 patients in the experimental group and 7 of 102 patients in the control group (2.0 vs. 6.9%; P = 0.03). The incidence rates of skin erosion were significantly lower, and the patient comfort score was much higher in the compression device group than in the control group (P < 0.01). Multivariable logistic regression analysis showed that the use of novel compression device was a significant protective factor for pocket hematoma (OR = 0.42; 95% CI, 0.29–0.69, P = 0.01).ConclusionsThe incidence of pocket hematomas and skin erosions significantly decreases when the proposed compression device is used for patients undergoing device implantation with uninterrupted DOACs. Thus, the length of hospital stay and re-operation rate can be reduced, and patient comfort can be improved.Clinical Trial Registrationhttp://www.chictr.org.cn, identifier: ChiCTR2100049430.
Collapse
Affiliation(s)
- Ye-Ping Fei
- Department of Cardiology, The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Lei Wang
- Department of General Practice, The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Chun-Yan Zhu
- Department of Cardiology, The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Jing-Chao Sun
- Department of Cardiology, The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Hui-Lin Hu
- Department of Cardiology, The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Chang-Lin Zhai
- Department of Cardiology, The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Chao-Jie He
- Department of Cardiology, The Affiliated Hospital of Jiaxing University, Jiaxing, China
- *Correspondence: Chao-Jie He
| |
Collapse
|
5
|
Shah B, Saidullah S, Aamer Niaz M, Zaman F, Parveen Z, Ghazanfar A, Mumtaz H. Strategies for the Long-Term Preservation of Site for Future Implantation of Cardiac Implantable Electronic Devices (CIEDs): Two Decades of Experience. Cureus 2022; 14:e22259. [PMID: 35350505 PMCID: PMC8933269 DOI: 10.7759/cureus.22259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2022] [Indexed: 11/05/2022] Open
|
6
|
Lind A, Ahsan M, Kaya E, Wakili R, Rassaf T, Jánosi RA. Early Pacemaker Implantation after Transcatheter Aortic Valve Replacement: Impact of PlasmaBlade™ for Prevention of Device-Associated Bleeding Complications. Medicina (B Aires) 2021; 57:medicina57121331. [PMID: 34946276 PMCID: PMC8707306 DOI: 10.3390/medicina57121331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 12/01/2021] [Accepted: 12/02/2021] [Indexed: 12/03/2022] Open
Abstract
Background and Objectives: Permanent pacemaker implantation (PPI) is frequently required following transcatheter aortic valve replacement (TAVR). Dual antiplatelet therapy (DAPT) or oral anticoagulation therapy (OAK) is often necessary in these patients since they are at higher risk of thromboembolic events due to TAVR implantation, high incidence of coronary artery diseases (CAD) with the necessity of coronary intervention, and high rate of atrial fibrillation with the need of stroke prevention. We sought to evaluate the safety, efficiency, and clinical outcomes of early PPI following TAVR using the PlasmaBlade™ (Medtronic Inc., Minneapolis, MN, USA) pulsed electron avalanche knife (PEAK) for bleeding control in patients under DAPT or OAK. Materials and Methods: This retrospective single-center study included patients who underwent PPI after transfemoral TAVR (TF) at our center between December 2015 and May 2020. All PPI were performed using the PlasmaBlade™ Device. Results: The overall PPI rate was 14.1% (83 of 587 patients; 82.5 ± 4.6 years; 45.8% male). The PPI procedures were used to treat high-grade atrioventricular block (81.9%), severe sinus node dysfunction (13.3%), and alternating bundle branch block (4.8%). At the time of the procedure, 35 (42.2%) patients received DAPT, and 48 (57.8%) patients received OAK (50% with vitamin K antagonist (VKA) and 50% with novel oral anticoagulants (NOAK)). One device-pocket hematoma treated conservatively occurred in a patient (1.2%) receiving NOAK. Two re-operations were necessary in patients due to immediate lead dislocation (2.4%). Conclusions: The results of this study illustrate that the use of PlasmaBlade™ for PPI in patients after a TAVR who require antithrombotic treatment is feasible and might result into lower rates of severe bleeding complications compared to rates reported in the literature. Use of the PlasmaBlade device may be considered in this specific group of patients because of their high risk of bleeding.
Collapse
|
7
|
Madias JE. Readers' Comments: Aspirin and/or Other Antiplatelet Agents for the Prevention of Infective Endocarditis. Am J Cardiol 2020; 125:1450-1451. [PMID: 32151433 DOI: 10.1016/j.amjcard.2020.01.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 01/29/2020] [Indexed: 11/27/2022]
|
8
|
Ferretto S, Mattesi G, Migliore F, Susana A, De Lazzari M, Iliceto S, Leoni L, Bertaglia E. Clinical predictors of pocket hematoma after cardiac device implantation and replacement. J Cardiovasc Med (Hagerstown) 2019; 21:123-127. [PMID: 31789710 DOI: 10.2459/jcm.0000000000000914] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
AIMS Pocket hematoma is a common complication of cardiac implantable electronic device (CIED) procedures. the aim of the study was to research the clinical factors associated with pocket hematoma formation after CIED implantation or replacement and to identify the best perioperative antithrombotic management. METHODS We retrospectively analyzed 500 consecutive patients who underwent to CIED implantation or replacement at our center from November 2014. RESULTS Among our population, 206 patients (41.2%) were on anticoagulant therapy at the time of the intervention: 68 (13.6%) on ongoing Warfarin; 111 (22.2%) on low-molecular-weight heparin (LMWH); and 27 (5.4%) on ongoing direct oral anticoagulants. Antiplatelet therapy was present in 262 (52.4%) patients: in particular, 50 (10%) were on dual antiplatelet therapy, 64 (12.8%) were on single antiplatelet therapy and anticoagulant therapy, whereas 12 (2.4%) were on anticoagulant with dual antiplatelet therapy.Incidence of pocket hematoma after CIEDs implantation was of 4.6%. Considering the different perioperative anticoagulant strategies, patients on LMWH presented the higher hematoma rate [11/100 patients (11.0%), P < 0.001]. At the multivariate analysis, anticoagulant with dual antiplatelet therapy (P = 0.021, OR 6.3, IC 1.3-30.8), left ventricular ejection fraction (LVEF) less than 30% (P < 0.001, OR 7.4, IC 2.7-20.4), and use of LMWH (P = 0.008, OR 3.8, IC 1.4-10.6) resulted the strongest predictors of pocket hematoma (Hosmer test = 0.899).Considering replacement procedures, incidence of pocket hematoma was of 4.4%. The incidence was higher after ICD/CRT-D replacement. The majority of pocket hematoma occurred in patients with mechanical valve prosthesis (3/4 cases, 75%, P < 0.001). CONCLUSION The use of LMWH and a low LVEF expose patients to a higher risk of pocket hematoma after CIED procedures. Anticoagulant with dual antiplatelet therapy and LMWH should be avoided.
Collapse
Affiliation(s)
- Sonia Ferretto
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua.,Department of Cardiology, San Donà di Piave Hospital, Venice, Italy
| | - Giulia Mattesi
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua
| | - Federico Migliore
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua
| | - Angela Susana
- Department of Cardiology, Cittadella Hospital, Padua, Italy
| | - Manuel De Lazzari
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua
| | - Sabino Iliceto
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua
| | - Loira Leoni
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua
| | - Emanuele Bertaglia
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua
| |
Collapse
|
9
|
Kaya E, Siebermair J, Azizy O, Dobrev D, Rassaf T, Wakili R. Use of pulsed electron avalanche knife (PEAK) PlasmaBlade™ in patients undergoing implantation of subcutaneous implantable cardioverter-defibrillator. IJC HEART & VASCULATURE 2019; 24:100390. [PMID: 31334332 PMCID: PMC6614530 DOI: 10.1016/j.ijcha.2019.100390] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 06/09/2019] [Accepted: 06/17/2019] [Indexed: 11/24/2022]
Abstract
Introduction Surgical implantation of subcutaneous implantable cardioverter-defibrillators (S-ICD) requires preparation of a deeper and larger pocket. Infection and bleeding complications are reported, particularly in patients requiring antiplatelet therapy (APT) or being on oral anticoagulation (OAC), with rates up to 25%. The pulsed electron avalanche knife (PEAK) PlasmaBlade™ has been reported to reduce bleeding complications. The purpose of this study was to evaluate the safety and feasibility of a PEAK guided S-ICD implantation with respect to perioperative complications. Methods and results We enrolled 36 consecutive patients (75% male; mean age 52.1 ± 14.4 years) undergoing S-ICD implantation. Periprocedural safety endpoints comprised major complications including pocket hematomas, wound infections, bleeding (BARC ≥2) or events requiring interventions. Patients were divided into three groups according to management of their anticoagulation: i.) APT, n = 15 (41.7%); ii.) OAC, n = 10 patients (27.8%); iii.) none (neither OAC nor APT), n = 11 (30.6%). Mean procedure duration was 33.1 ± 13.4 min. Mean length of hospital stay was 3.3 ± 2.1 days. Overall analysis showed no differences between the 3 groups with respect to major complications, major bleeding episodes or other procedural parameters, beside a trend towards more minor hematomas in the OAC group (OAC: 22.2% vs. APT: 11.4% vs. none: 9.1%; p = 0.15). Conclusion The results of our pilot study suggest that intermuscular S-ICD implantation using PEAK is safe and potentially beneficial in patients receiving OAC or APT with respect to prevention of bleeding complications. These results support the rationale for large prospective controlled trials evaluating a beneficial effect of PEAK use in S-ICD implantation procedures.
Collapse
Key Words
- ASA, American Society of Anesthesiologists
- AST, Automated screening tool
- Anticoagulation
- Bleeding complication
- CAD, Coronary artery disease
- CIED, Cardiac implantable electronic device
- DFT, Defibrillation threshold
- DOAC, Direct oral anticoagulant
- ICD, Implantable cardioverter-defibrillator
- INR, International normalized ratio
- IVF, Idiopathic ventricular fibrillation
- Intermuscular technique
- J, Joule
- M, Musculus
- PEAK PlasmaBlade™
- S-ICD
- S-ICD, Subcutaneous implantable cardioverter-defibrillator
- SCD, Sudden cardiac death
- VF, Ventricular fibrillation
- VKA, Vitamin K antagonist
Collapse
Affiliation(s)
- Elif Kaya
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Johannes Siebermair
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Obayda Azizy
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Dobromir Dobrev
- Institute of Pharmacology, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Tienush Rassaf
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Reza Wakili
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| |
Collapse
|
10
|
Stewart MH, Morin DP. Management of Perioperative Anticoagulation for Device Implantation. Card Electrophysiol Clin 2018; 10:99-109. [PMID: 29428146 DOI: 10.1016/j.ccep.2017.11.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Periprocedural management of anticoagulation for cardiac device implantation has evolved over the past 20 years. The traditional paradigm of vitamin K antagonist interruption with heparin bridging has now been shown to be less safe than continuation of vitamin K antagonists at therapeutic levels. Dual antiplatelet therapy during device implantation poses substantial risk but is often necessary. The safest dosing strategy for newer direct oral anticoagulants is still not clear.
Collapse
Affiliation(s)
- Merrill H Stewart
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School, University of Queensland School of Medicine, 1514 Jefferson Highway, New Orleans, LA 70121, USA
| | - Daniel P Morin
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School, University of Queensland School of Medicine, 1514 Jefferson Highway, New Orleans, LA 70121, USA.
| |
Collapse
|
11
|
Mukherjee SS, Saggu D, Chennapragada S, Yalagudri S, Nair SG, CalamburNarasimhan. Device implantation for patients on antiplatelets and anticoagulants: Use of suction drain. Indian Heart J 2018; 70 Suppl 3:S389-S393. [PMID: 30595295 PMCID: PMC6309121 DOI: 10.1016/j.ihj.2017.12.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 12/21/2017] [Accepted: 12/31/2017] [Indexed: 11/30/2022] Open
Abstract
Background and objectives Cardiovascular implantable electronic devices (CIED) are frequently implanted in patients on anti-thrombotic agents. Pocket hematomas are more likely to occur in these patients. The use of a sterile surgical drain in the pulse generator pocket site could prevent hematomas, but fear of infection precludes its use. The objective of the present study is to study the safety and efficacy of surgical drain in patients on antithrombotics undergoing CIED implantations. Methods This is a single-centre, retrospective study involving patients undergoing CIED implantations on antithrombotics (antiplatelets and anticoagulants) from August 2013 to July 2016. Patients with high risk of thromboembolism were continued on oral antithrombotics or were bridged with heparin after stopping oral antithrombotics. A sterile close wound suction drain was placed in device pockets following CIED implantations. Post procedure, pressure dressing was applied and removed after 12 h once the drain volume was less than 10 ml in 24 h. Results Sixty seven patients required surgical drain implantation. Major indications for antithrombotic use were presence of intracoronary stent, atrial fibrillation and mechanical valve replacements. The mean post-procedural hospital stay was 3 ± 0.9 days and mean overall drain was 16.6 ± 8.2 ml. At a mean follow up of 17.6 ± 8.2 months, one patient (1.4%) had pocket hematoma. There were no infections. Conclusion The use of a surgical drain in CIED implantation significantly reduces the risk of hematoma formation without increasing the risk of infection. Antithrombotic drugs can be safely continued at the time of implantation of cardiac devices.
Collapse
Affiliation(s)
| | - Daljeet Saggu
- Department of Cardiology, CARE Hospital, Banjara Hills, Hyderabad, India
| | | | - Sachin Yalagudri
- Department of Cardiology, CARE Hospital, Banjara Hills, Hyderabad, India
| | - Sandeep G Nair
- Department of Cardiology, CARE Hospital, Banjara Hills, Hyderabad, India
| | - CalamburNarasimhan
- Department of Cardiology, CARE Hospital, Banjara Hills, Hyderabad, India.
| |
Collapse
|
12
|
He H, Ke BB, Li Y, Han FS, Li X, Zeng YJ. Perioperative management of antithrombotic therapy in patients receiving cardiovascular implantable electronic devices: a network meta-analysis. J Interv Card Electrophysiol 2017; 50:65-83. [PMID: 28842832 DOI: 10.1007/s10840-017-0280-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Accepted: 08/10/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE Network meta-analysis (NMA) has advantages including being able to simultaneously compare and rank multiple treatments over traditional meta-analysis. We evaluated by a NMA the optimal antithrombotic strategy during the perioperative period of implantation of cardiovascular implantable electronic devices (CIEDs). METHODS We performed a network meta-analysis of observational studies (cohort and case-control studies). The eligible studies tested the following antithrombotic therapy during the CIED placement: aspirin, clopidogrel, warfarin, novel oral anticoagulants (NOACs), and heparin bridging. RESULTS Thirty-one observational studies with 119 study arms were included (41,174 patients receiving long-term antithrombotic therapy; median age, 72.6 years; 70.1% males; median follow-up, 3.6 years). Aspirin (4.26 [2.88-7.22]), warfarin (3.37 [2.17-5.23]), and clopidogrel (3.30 [1.49-5.88]) reduced the risk of bleeding as compared with heparin bridging, and there was no significance difference between continued NOACs and heparin bridging (0.67 [0.21-2.18]). The comparison of commonly used protocols in the management of anticoagulant therapy revealed that continued warfarin (0.38 [0.20-0.74]), continued NOACs (0.19 [0.04-0.89]), and heparin bridging therapy (0.01 [0.05-0.21]) increased the risk of bleeding as compared that of control, and continued warfarin (3.74 [1.96-7.16]), interrupted warfarin (4.89 [2.20-10.88]), and interrupted NOACs (12.5 [1.25-100]) reduced the risk of bleeding compared with that of heparin bridging. CONCLUSIONS Among various antithrombotic drugs, aspirin had the lowest bleeding risk, followed by warfarin, clopidogrel and NOACs, and heparin, with the greatest bleeding risk. NOACs therapy appears safe and effective, and interrupted NOACs may be the optimal anticoagulation protocol for use during the perioperative period of CIED implantation.
Collapse
Affiliation(s)
- Hua He
- Department of Emergency Cardiology, Beijing Anzhen Hospital, Capital Medical University, Anzhen Road Second, Chaoyang District, Beijing, 100029, People's Republic of China.
| | - Bing-Bing Ke
- Department of Emergency Cardiology, Beijing Anzhen Hospital, Capital Medical University, Anzhen Road Second, Chaoyang District, Beijing, 100029, People's Republic of China
| | - Yan Li
- Department of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Disease, Beijing, 100029, China
| | - Fu-Sheng Han
- Department of Emergency Cardiology, Beijing Anzhen Hospital, Capital Medical University, Anzhen Road Second, Chaoyang District, Beijing, 100029, People's Republic of China
| | - Xiaodong Li
- Department of Emergency Cardiology, Beijing Anzhen Hospital, Capital Medical University, Anzhen Road Second, Chaoyang District, Beijing, 100029, People's Republic of China
| | - Yu-Jie Zeng
- Department of Emergency Cardiology, Beijing Anzhen Hospital, Capital Medical University, Anzhen Road Second, Chaoyang District, Beijing, 100029, People's Republic of China
| |
Collapse
|
13
|
Giofrè F, Ferrari P, Leidi C, Foschi ML, Senni M, De Filippo P. External closed-circuit cooling system for management of patients after device implantation: A feasibility study. Int J Cardiol 2017; 241:235-237. [PMID: 28446377 DOI: 10.1016/j.ijcard.2017.04.048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 04/03/2017] [Accepted: 04/17/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND In the first 24h after pacemaker or implantable cardioverter/defibrillator (ICD) implantation or replacement, the occurrence of hematoma and pain in the surgically treated region is not infrequent and may result in re-intervention and/or more severe complications, such as infections. Currently, the post-implant phase management is very empiric. The aim of this study was to test the clinical applicability and usefulness of an external close-circuit cooling system for the management of the early post-implant period in patients with high risk of hematoma due to anticoagulant and/or antiplatelet therapy. METHODS We studied 135 patients (78M; 71±11years) with high risk of hematoma occurrence after pace-maker (63 patients) or ICD (72 patients) implantation or replacement. Immediately after the intervention, a closed-circuit cooling system (CAREPACE™ system, Zamar, Italy) was externally applied on the pre-pectoral region to each patient and maintained for 24h. The system has a compressive pad and a refrigerating circuit in which non-toxic glycolic fluid is pumped. The fluid temperature was set and kept at 5°C for the whole period. RESULTS The compressive and cooling effect of the system was well tolerated by all the patients at the temperature set. Four patients complained of noise due to machine operation, but in none the treatment was interrupted. The average length of hospital stay was 2.8±0.4days. No clinically significant hematoma was observed at discharge and after one month follow-up visit. CONCLUSIONS This new system can be used for the management of the early phase after device implantation or replacement and appears clinically useful and well tolerated. Further studies on a larger scale are needed to test the potential reduction of post-intervention complications and the cost-effectiveness of this device.
Collapse
Affiliation(s)
- Fabrizio Giofrè
- Cardiac Electrophysiology and Pacing Unit, Cardiovascular Department, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Paola Ferrari
- Cardiac Electrophysiology and Pacing Unit, Cardiovascular Department, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Cristina Leidi
- Cardiac Electrophysiology and Pacing Unit, Cardiovascular Department, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Maria Laura Foschi
- Cardiac Electrophysiology and Pacing Unit, Cardiovascular Department, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Michele Senni
- Cardiovascular Department, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Paolo De Filippo
- Cardiac Electrophysiology and Pacing Unit, Cardiovascular Department, Ospedale Papa Giovanni XXIII, Bergamo, Italy.
| |
Collapse
|
14
|
Koh Y, Bingham NE, Law N, Le D, Mariani JA. Cardiac implantable electronic device hematomas: Risk factors and effect of prophylactic pressure bandaging. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2017; 40:857-867. [PMID: 28543543 DOI: 10.1111/pace.13106] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 04/14/2017] [Accepted: 04/24/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND Cardiac implantable electronic device (CIED) hematomas are associated with many adverse outcomes. We examined the incidence and risk factors associated with hematoma formation post-CIED implantation, and explored the preventative effect of prophylactic pressure bandaging (PPB) in a large tertiary center. METHODS 1,091 devices were implanted during October 2011-December 2014. Clinically significant hematomas (CSH) were those that necessitated prolonged admission, including those due to reoperation, and clinically suspicious hematomas were swellings noted by medical/nursing staff. We screened for variables affecting hematoma incidence prior to conducting multivariate logistic regression analyses, one for all hematomas and one for CSH. RESULTS 61 hematomas were identified (5.6% of patients), with 12 of those clinically significant (1.1% of patients). Factors significantly increasing the odds of developing any hematoma were stage 2 (odds ratio [OR] = 2.93, 95% confidence interval [CI] [1.08-7.94], P = 0.034) and 3 chronic kidney disease (CKD) (OR = 3.39 [1.20-9.56], P = 0.021), unfractionated heparin/therapeutic enoxaparin (OR = 3.15 [1.22-8.14], P = 0.018), and dual antiplatelets-aspirin + clopidogrel (OR = 2.95 [1.14-7.65], P = 0.026) + other combinations. Body Mass index (BMI) 25.0-29.9 (OR 0.52 [0.28-0.98], P = 0.044) and >30 were associated with decreased hematoma risk (OR 0.43 [0.20-0.91], P = 0.028). Factors significant for CSH formation were unfractionated heparin/therapeutic enoxaparin (OR = 9.55 [1.83-49.84], P = 0.007) and aspirin + clopidogrel (OR = 7.19 [1.01-50.91], P = 0.048). PPB nonsignificantly increased the odds of total hematoma development (OR = 1.53 [0.87-2.69], P = 0.135), and reduced CSH (OR = 0.67 [0.18-2.47], P = 0.547). CONCLUSIONS Heparin and dual antiplatelet use remain strong predictors of overall hematoma formation. CKD is a comparatively moderate predictor. BMI > 25 may decrease the risk of hematoma formation. PPB had nonsignificant effects on hematoma development.
Collapse
Affiliation(s)
- Youlin Koh
- Department of Cardiology, The Alfred Hospital, Prahran, Victoria, Australia
| | - Nicholas E Bingham
- Department of Cardiology, The Alfred Hospital, Prahran, Victoria, Australia
| | - Natalie Law
- Monash University, Clayton, Victoria, Australia
| | - Dustin Le
- Monash University, Clayton, Victoria, Australia
| | - Justin A Mariani
- Department of Cardiology, The Alfred Hospital, Prahran, Victoria, Australia.,Baker IDI Heart and Diabetes Institute, Prahran, Victoria, Australia, 3004
| |
Collapse
|
15
|
Turagam MK, Nagarajan DV, Bartus K, Makkar A, Swarup V. Use of a pocket compression device for the prevention and treatment of pocket hematoma after pacemaker and defibrillator implantation (STOP-HEMATOMA-I). J Interv Card Electrophysiol 2017; 49:197-204. [DOI: 10.1007/s10840-017-0235-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 02/22/2017] [Indexed: 11/28/2022]
|
16
|
Demir GG, Guler GB, Guler E, Güneş H, Kizilirmak F, Karaca İO, Omaygenç MO, Çakal B, Olgun E, Savur U, Ibisoglu E, Barutçu I, Kiliçaslan F. Pocket haematoma after cardiac electronic device implantation in patients receiving antiplatelet and anticoagulant treatment: a single-centre experience. Acta Cardiol 2017; 72:47-52. [PMID: 28597740 DOI: 10.1080/00015385.2017.1281539] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Objective In modern cardiology practice, implantation of cardiac electronic devices in patients taking anticoagulant or antiplatelet therapy is a common clinical scenario. Bleeding complications are of particular concern in this patient population and pocket haematoma is one of the most frequent complications. We sought to determine the relationship between periprocedural antiplatelet/anticoagulant therapy and pocket haematoma formation in patients undergoing cardiac implantable electronic device (CIED) implantation. Methods We conducted a retrospective study including 232 consecutive patients undergoing CIED implantation in the department of cardiology of the Medipol University Hospital. Patients were divided into six groups: clopidogrel group (n = 12), acetylsalicylic acid (ASA) group (n = 73), ASA + clopidogrel group (n = 29), warfarin group (n = 34), warfarin + ASA group (n = 21) and no antiplatelet-anticoagulant therapy group as the control group (n = 63). CIED implantations were stratified under four subtitles including implantable cardioverter/defibrillator (ICD), cardiac resynchronization therapy (CRT), permanent pacemaker and the last group as either device upgrade or generator replacement. Results The mean age of the patients was 63 ± 14 years and 140 patients were male (60.3%). A pocket haematoma was documented in 6 of 232 patients (2.6%). None of the patients with pocket haematoma needed pocket exploration or blood transfusion. The type of the device did not have a significant effect on pocket haematoma incidence (P = 0.250). Univariate logistic regression showed that platelet level and ASA plus clopidogrel use were significantly associated with haematoma frequency after CIED implantations, respectively (OR: 0.977, CI 95% [0.958-0.996]; OR: 16.080, CI 95% [2.801-92.306]). Multivariate analysis revealed that dual antiplatelet treatment (β = 3.016, P = 0.002, OR: 2.410, 95% CI [3.042-136.943]) and baseline platelet level (β = -0.027, p:0.025, OR: 0.974, 95% CI [0.951-0.997]) were independent risk factors for pocket haematoma formation. Conclusion Dual antiplatelet therapy and low platelet levels significantly increased the risk of pocket haematoma formation in patients undergoing CIED implantations.
Collapse
Affiliation(s)
| | - Gamze Babur Guler
- Medipol University Medicine Faculty, Cardiology Department, Istanbul, Turkey
| | - Ekrem Guler
- Medipol University Medicine Faculty, Cardiology Department, Istanbul, Turkey
| | - HacıMurat Güneş
- Medipol University Medicine Faculty, Cardiology Department, Istanbul, Turkey
| | - Filiz Kizilirmak
- Medipol University Medicine Faculty, Cardiology Department, Istanbul, Turkey
| | - İbrahim Oğuz Karaca
- Medipol University Medicine Faculty, Cardiology Department, Istanbul, Turkey
| | | | - Beytullah Çakal
- Medipol University Medicine Faculty, Cardiology Department, Istanbul, Turkey
| | - Erkam Olgun
- Medipol University Medicine Faculty, Cardiology Department, Istanbul, Turkey
| | - Umeyr Savur
- Medipol University Medicine Faculty, Cardiology Department, Istanbul, Turkey
| | - Ersın Ibisoglu
- Medipol University Medicine Faculty, Cardiology Department, Istanbul, Turkey
| | - Irfan Barutçu
- Medipol University Medicine Faculty, Cardiology Department, Istanbul, Turkey
| | - Fethi Kiliçaslan
- Medipol University Medicine Faculty, Cardiology Department, Istanbul, Turkey
| |
Collapse
|
17
|
Sridhar ARM, Yarlagadda V, Kanmanthareddy A, Parasa S, Maybrook R, Dawn B, Reddy YM, Lakkireddy D. Incidence, predictors and outcomes of hematoma after ICD implantation: An analysis of a nationwide database of 85,276 patients. Indian Pacing Electrophysiol J 2016; 16:159-164. [PMID: 27979375 PMCID: PMC5153424 DOI: 10.1016/j.ipej.2016.10.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 10/21/2016] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Pocket 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. METHODS Data 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. RESULTS Out 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). CONCLUSION Hematoma occurs infrequently after ICD implantation, however, it adversely impacts the cost of procedure and length of stay.
Collapse
Affiliation(s)
| | - Vivek Yarlagadda
- Division of Cardiovascular Diseases, Cardiovascular Research Institute, The University of Kansas Hospital & Medical Center, 3901 Rainbow Boulevard MS 4023, Kansas City, KS 66160-7200, USA
| | - Arun Kanmanthareddy
- Division of Cardiovascular Diseases, Cardiovascular Research Institute, The University of Kansas Hospital & Medical Center, 3901 Rainbow Boulevard MS 4023, Kansas City, KS 66160-7200, USA
| | - Sravanthi Parasa
- The University of Kanas Medical Center, 3901 Rainbow Boulevard MS 4023, Kansas City, KS 66160-7200, USA
| | - Ryan Maybrook
- Division of Cardiovascular Diseases, Cardiovascular Research Institute, The University of Kansas Hospital & Medical Center, 3901 Rainbow Boulevard MS 4023, Kansas City, KS 66160-7200, USA
| | - Buddhadeb Dawn
- Division of Cardiovascular Diseases, Cardiovascular Research Institute, The University of Kansas Hospital & Medical Center, 3901 Rainbow Boulevard MS 4023, Kansas City, KS 66160-7200, USA
| | - Yeruva Madhu Reddy
- Division of Cardiovascular Diseases, Cardiovascular Research Institute, The University of Kansas Hospital & Medical Center, 3901 Rainbow Boulevard MS 4023, Kansas City, KS 66160-7200, USA
| | - Dhanunjaya Lakkireddy
- Division of Cardiovascular Diseases, Cardiovascular Research Institute, The University of Kansas Hospital & Medical Center, 3901 Rainbow Boulevard MS 4023, Kansas City, KS 66160-7200, USA.
| |
Collapse
|
18
|
Beton O, Saricam E, Kaya H, Yucel H, Dogdu O, Turgut OO, Berkan O, Tandogan I, Yilmaz MB. Bleeding complications during cardiac electronic device implantation in patients receiving antithrombotic therapy: is there any value of local tranexamic acid? BMC Cardiovasc Disord 2016; 16:73. [PMID: 27105588 PMCID: PMC4841978 DOI: 10.1186/s12872-016-0251-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 04/20/2016] [Indexed: 11/10/2022] Open
Abstract
Background The perioperative use of antithrombotic therapy is associated with increased bleeding risk after cardiac implantable electronic device (CIED) implantation. Topical application of tranexamic acid (TXA) is effective in reducing bleeding complications after various surgical operations. However, there is no information regarding local TXA application during CIED procedures. The purpose of our study was to evaluate bleeding complications rates during CIED implantation with and without topical TXA use in patients receiving antithrombotic treatment. Methods We conducted a retrospective analysis of consecutive patients undergoing CIED implantation while receiving warfarin or dual antiplatelet (DAPT) or warfarin plus DAPT treatment. Study population was classified in two groups according to presence or absence of topical TXA use during CIED implantation. Pocket hematoma (PH), major bleeding complications (MBC) and thromboembolic events occuring within 90 days were compared. Results A total of 135 consecutive patients were identified and included in the analysis. The mean age was 60 ± 11 years old. Topical TXA application during implantation was reported in 52 patients (TXA group). The remaining 83 patients were assigned to the control group. PH occurred in 7.7 % patients in the TXA group and 26.5 % patients in the control group (P = 0.013). The MBC was reported in 5.8 % patients in the TXA and 20.5 % patients in control group (P = 0.024). Univariate logistic regression analysis identified age, history of recent stent implantation, periprocedural spironolactone use, periprocedural warfarin use, perioperative warfarin plus DAPT use, cardiac resynchronization therapy, and topical TXA application during CIED implantation as predicting factors of PH. Multivariate analysis showed that perioperative warfarin plus DAPT use (OR = 10.874, 95 % CI: 2.496–47.365, P = 0.001) and topical TXA application during CIED procedure (OR = 0.059, 95 % CI: 0.012–0.300, P = 0.001) were independent predictors of PH. Perioperative warfarin plus DAPT use and topical TXA application were also found to be independent predictors of MBC in multivariate analyses. No thromboembolic complications was recorded in the study group. Conclusion The present study demonstrated that the topical TXA application during CIED implantation is associated with reduced PH and MBC in patients with high bleeding risk. Electronic supplementary material The online version of this article (doi:10.1186/s12872-016-0251-1) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Osman Beton
- Department of Cardiology, Heart Center, University Hospital, Faculty of Medicine, Cumhuriyet University, Postal Code: 58140, Sivas, Turkey.
| | - Ersin Saricam
- Cardiology Clinic, Cag Hospital, Ankara, Turkey.,Cardiology Clinic, Koru International Hospital, Ankara, Turkey
| | - Hakki Kaya
- Department of Cardiology, Heart Center, University Hospital, Faculty of Medicine, Cumhuriyet University, Postal Code: 58140, Sivas, Turkey
| | - Hasan Yucel
- Department of Cardiology, Heart Center, University Hospital, Faculty of Medicine, Cumhuriyet University, Postal Code: 58140, Sivas, Turkey
| | - Orhan Dogdu
- Department of Cardiology, University Hospital, Faculty of Medicine, Firat University, Elazig, Turkey
| | - Okan Onur Turgut
- Department of Cardiology, Heart Center, University Hospital, Faculty of Medicine, Cumhuriyet University, Postal Code: 58140, Sivas, Turkey
| | - Ocal Berkan
- Department of Cardiovascular Surgery, Heart Center, University Hospital, Faculty of Medicine, Cumhuriyet University, Sivas, Turkey
| | - Izzet Tandogan
- Cardiology Clinic, Gozde Academy Hospital, Malatya, Turkey
| | - Mehmet Birhan Yilmaz
- Department of Cardiology, Heart Center, University Hospital, Faculty of Medicine, Cumhuriyet University, Postal Code: 58140, Sivas, Turkey
| |
Collapse
|
19
|
Abstract
Implantation of cardiac implantable electronic devices (CIEDs), including pacemakers, implantable cardioverter-defibrillators, and biventricular pacemakers/cardioverter-defibrillators, is becoming increasingly common with new implants now exceeding 1.5 million per year globally. As a result, health care providers in all disciplines are caring for an increasing number of patients with CIEDs. Although the risk of complications associated with implantation of CIEDs is relatively low, the sequela can be catastrophic. Management requires an understanding of an individual patient’s indication for CIED implant, the steps of implant procedures, device function, and natural history of each complication.
Collapse
Affiliation(s)
- Melissa E. Harding
- Melissa E. Harding is Cardiac Electrophysiology Physician Assistant, New York University Langone Medical Center, 560 1st Ave, New York, NY 10016
| |
Collapse
|
20
|
Sticherling C, Marin F, Birnie D, Boriani G, Calkins H, Dan GA, Gulizia M, Halvorsen S, Hindricks G, Kuck KH, Moya A, Potpara T, Roldan V, Tilz R, Lip GY, Gorenek B, Indik JH, Kirchhof P, Ma CS, Narasimhan C, Piccini J, Sarkozy A, Shah D, Savelieva I. Antithrombotic management in patients undergoing electrophysiological procedures: a European Heart Rhythm Association (EHRA) position document endorsed by the ESC Working Group Thrombosis, Heart Rhythm Society (HRS), and Asia Pacific Heart Rhythm Society (APHRS). ACTA ACUST UNITED AC 2015; 17:1197-214. [DOI: 10.1093/europace/euv190] [Citation(s) in RCA: 134] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
|
21
|
Sridhar ARM, Yarlagadda V, Yeruva MR, Kanmanthareddy A, Vallakati A, Dawn B, Lakkireddy D. Impact of haematoma after pacemaker and CRT device implantation on hospitalization costs, length of stay, and mortality: a population-based study. Europace 2015; 17:1548-54. [DOI: 10.1093/europace/euv075] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 02/26/2015] [Indexed: 11/13/2022] Open
|
22
|
Yang X, Wang Z, Zhang Y, Yin X, Hou Y. The safety and efficacy of antithrombotic therapy in patients undergoing cardiac rhythm device implantation: a meta-analysis. Europace 2015; 17:1076-84. [PMID: 25713013 DOI: 10.1093/europace/euu369] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 11/27/2014] [Indexed: 11/14/2022] Open
Abstract
AIMS The meta-analysis was to assess the safety and efficacy of periprocedural antithrombotic therapy and to evaluate the risk factors potentially associated with bleeding among patients undergoing cardiac implantable electronic devices implantations. METHODS AND RESULTS A systematic literature search of PubMed, EMBASE, and Cochrane Controlled Trials Register was performed. Anticoagulation and antiplatelet therapies were assessed separately. Uninterrupted anticoagulation was associated with significant lower bleeding risk compared with heparin bridging strategy [odds ratio (OR) = 0.31, 95% confidence interval (CI) 0.18-0.53, and P < 0.0001], but there was no significant difference in thromboembolic risk between these two strategies (OR = 0.82, 95% CI 0.32-2.09, and P = 0.65). The haematoma rate was significantly increased in dual antiplatelet therapy group (OR = 6.84, 95% CI 4.16-11.25, and P < 0.00001), but not in single antiplatelet therapy (OR = 1.52, 95% CI 0.93-2.46, and P = 0.09). Clopidogrel increased the risk of haematoma vs. aspirin (OR = 2.91, 95% CI 1.27-6.69, and P = 0.01). Otherwise, a lower risk of haematoma was observed in pacemaker group vs. cardiac resynchronization therapy and/or implantable cardioverter defibrillator group (OR = 0.64, 95% CI 0.50-0.82, and P = 0.0004). CONCLUSION This meta-analysis suggested that uninterrupted oral anticoagulation seems to be the better strategy, associated with a lower risk of bleeding complications rather than heparin bridging, and dual antiplatelet therapy carried a significant risk of bleeding whereas single antiplatelet therapy was relatively safe among patients undergoing cardiac implantable electronic devices implantations. Meanwhile, cardiac resynchronization therapy and/or implantable cardioverter defibrillator implantations increase the bleeding.
Collapse
Affiliation(s)
- Xiaowei Yang
- Qianfoshan Hospital of Shandong University, Jinan City, Shandong, People's Republic of China Department of Clinical Pharmacy (Seven-Year), School of Pharmaceutical Sciences, Shandong University, Jinan City, Shandong, People's Republic of China
| | - Zhongsu Wang
- Department of Cardiology, Shandong Provincial Qianfoshan Hospital, Shandong University, No. 16766 Jingshi Road, Jinan City 250014, People's Republic of China
| | - Yong Zhang
- Department of Cardiology, Shandong Provincial Qianfoshan Hospital, Shandong University, No. 16766 Jingshi Road, Jinan City 250014, People's Republic of China
| | - Xiangcui Yin
- Department of Science and Education, Shandong Provincial Qianfoshan Hospital, Shandong University, No. 16766 Jingshi Road, Jinan City 250014, People's Republic of China
| | - Yinglong Hou
- Department of Cardiology, Shandong Provincial Qianfoshan Hospital, Shandong University, No. 16766 Jingshi Road, Jinan City 250014, People's Republic of China
| |
Collapse
|
23
|
Clinical considerations for allied professionals: optimizing outcomes: surgical incision techniques and wound care in device implantation. Heart Rhythm 2014; 11:737-41. [PMID: 24394158 DOI: 10.1016/j.hrthm.2014.01.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Indexed: 11/23/2022]
|
24
|
Özcan KS, Osmonov D, Yıldırım E, Altay S, Türkkan C, Ekmekçi A, Güngör B, Erdinler İ. Hematoma complicating permanent pacemaker implantation: The role of periprocedural antiplatelet or anticoagulant therapy. J Cardiol 2013; 62:127-30. [DOI: 10.1016/j.jjcc.2013.03.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Revised: 03/06/2013] [Accepted: 03/08/2013] [Indexed: 11/26/2022]
|
25
|
Perioperative management of anticoagulation in patients on warfarin therapy undergoing surgery for cardiac implantable electronic devices. J Arrhythm 2013. [DOI: 10.1016/j.joa.2013.01.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
|
26
|
SCHWERG MARIUS, BALDENHOFER GERD, DREGER HENRYK, BONDKE HANSJÜRGEN, STANGL KARL, LAULE MICHAEL, MELZER CHRISTOPH. Complete Atrioventricular Block after TAVI: When Is Pacemaker Implantation Safe? Pacing Clin Electrophysiol 2013; 36:898-903. [DOI: 10.1111/pace.12150] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2012] [Revised: 01/28/2013] [Accepted: 02/18/2013] [Indexed: 11/29/2022]
Affiliation(s)
- MARIUS SCHWERG
- Medizinische Klinik für Kardiologie und Angiologie; Campus Mitte; Charité-Universitätsmedizin Berlin; Germany
| | - GERD BALDENHOFER
- Medizinische Klinik für Kardiologie und Angiologie; Campus Mitte; Charité-Universitätsmedizin Berlin; Germany
| | - HENRYK DREGER
- Medizinische Klinik für Kardiologie und Angiologie; Campus Mitte; Charité-Universitätsmedizin Berlin; Germany
| | - HANSJÜRGEN BONDKE
- Medizinische Klinik für Kardiologie und Angiologie; Campus Mitte; Charité-Universitätsmedizin Berlin; Germany
| | - KARL STANGL
- Medizinische Klinik für Kardiologie und Angiologie; Campus Mitte; Charité-Universitätsmedizin Berlin; Germany
| | - MICHAEL LAULE
- Medizinische Klinik für Kardiologie und Angiologie; Campus Mitte; Charité-Universitätsmedizin Berlin; Germany
| | - CHRISTOPH MELZER
- Medizinische Klinik für Kardiologie und Angiologie; Campus Mitte; Charité-Universitätsmedizin Berlin; Germany
| |
Collapse
|
27
|
Finkel JB, Marhefka GD, Weitz HH. Dual antiplatelet therapy with aspirin and clopidogrel: what is the risk in noncardiac surgery? A narrative review. Hosp Pract (1995) 2013; 41:79-88. [PMID: 23466970 DOI: 10.3810/hp.2013.02.1013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Clopidogrel is one of the most commonly prescribed medications and is currently recommended along with aspirin as treatment to be used for 1 year in all patients without contraindications following an acute coronary syndrome. Patients who are committed to clopidogrel therapy due to recent coronary artery stent implantation may require noncardiac surgery during this recommended period of dual antiplatelet therapy (DAPT). Due to differing rates of endothelialization, patients who undergo bare-metal stent implantation generally require ≥ 1 month of uninterrupted DAPT, and those who undergo drug-eluting stent implantation require ≥ 12 months. Many surgeons ask their patients to stop taking clopidogrel in advance of their procedure to decrease perioperative bleeding. This practice is based largely on anecdotal experience and extrapolated from limited data in cardiac surgery. Premature cessation of aspirin and/or clopidogrel following coronary artery stenting, however, has been associated with acute stent thrombosis, myocardial infarction, and death. We searched PubMed for English language articles published from 1960 to 2012, using the keywords aspirin, clopidogrel, surgery, general, vascular, genitourinary, thoracic, orthopedic, ophthalmologic, dermatologic, endoscopy, colonoscopy, cardiac device implantation, pacemaker, defibrillator, bronchoscopy, bridging, bleeding complications, and transfusion, including various combinations. s were reviewed to confirm relevance, and then the full articles were extracted. References from extracted articles were also reviewed for relevant articles. Literature regarding perioperative clopidogrel continuation is predominantly composed of small, nonrandomized data, but suggests that most noncardiac surgeries or procedures can be performed safely while patients are taking clopidogrel. In this article, we review the current best evidence on the risk for bleeding with clopidogrel therapy in noncardiac surgery, summarize recent guidelines on appropriate duration of DAPT, and make recommendations on the management of perioperative DAPT.
Collapse
Affiliation(s)
- Jonathan B Finkel
- Department of Internal Medicine, Thomas Jefferson University Hospitals, Philadelphia, PA, USA
| | | | | |
Collapse
|
28
|
Hsu JC, Varosy PD, Bao H, Wang Y, Curtis JP, Marcus GM. Low body mass index but not obesity is associated with in-hospital adverse events and mortality among implantable cardioverter-defibrillator recipients: insights from the National Cardiovascular Data Registry. J Am Heart Assoc 2012; 1:e003863. [PMID: 23316325 PMCID: PMC3540679 DOI: 10.1161/jaha.112.003863] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Accepted: 08/30/2012] [Indexed: 11/25/2022]
Abstract
Background Implantable cardioverter-defibrillators (ICDs) are placed in patients at risk for sudden cardiac death, but the procedure may cause adverse events. Patient body habitus may be an important factor responsible for ICD implantation complications. We assessed whether underweight or obese compared with normal weight patients, as defined by body mass index (BMI), were at increased risk for adverse events from ICD implantation. Methods and Results We studied 83 312 first-time ICD recipients in the National Cardiovascular Data Registry-ICD Registry implanted between April 2010 and June 2011. Using hierarchical multivariable logistic regression adjusted for patient demographic and clinical characteristics, we examined the association of BMI with in-hospital complications, length of hospital stay, and mortality. Underweight (BMI ≤18.5 kg/m2) patients comprised 1.7% of the cohort (n=1434), whereas obese (BMI≥30 kg/m2) patients comprised 40.1% (n=33 339). Overall, a higher proportion of underweight patients experienced complications (normal weight, 2.3%; obese, 2.1%; underweight 5.2%; P<0.0001) and death (normal weight, 0.3%; obese, 0.3%; underweight 0.8%; P=0.026) as a result of ICD implantation. After multivariable adjustment, underweight ICD recipients had a greater odds of complications (odds ratio [OR], 2.15; 95% confidence interval [CI], 1.68 to 2.75; P<0.0001), hospital stay >3 days (OR, 1.62; 95% CI, 1.38 to 1.89; P<0.0001), and in-hospital death (OR, 2.27; 95% CI, 1.21 to 4.27; P=0.011) compared with normal weight patients. Obese patients did not exhibit any meaningful differences in the same outcomes. Conclusions In a large, real-world population, underweight first-time ICD recipients experienced significantly more periprocedural complications, prolonged hospital stays, and in-hospital death compared with normal weight patients.
Collapse
Affiliation(s)
- Jonathan C Hsu
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California, San Francisco, CA, USA.
| | | | | | | | | | | |
Collapse
|
29
|
Tratamiento perioperatorio del paciente con antiagregación o anticoagulación. REVISTA COLOMBIANA DE CARDIOLOGÍA 2012. [DOI: 10.1016/s0120-5633(12)70141-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
30
|
Rossillo A, Corrado A, China P, Madalosso M, Themistoclakis S. Anticoagulation Issues in Patients with AF. Card Electrophysiol Clin 2012; 4:363-373. [PMID: 26939956 DOI: 10.1016/j.ccep.2012.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The evaluation of the risk of stroke for individual patients with atrial fibrillation (AF) is a crucial factor in the decision to provide anticoagulation therapy. Novel oral anticoagulants, as compared with warfarin, are associated with a lower or similar rate of stroke and systemic embolism and a lower rate of hemorrhagic stroke. These drugs are administered at a fixed dose, have a shorter peak action and half-life, and do not require international normalized ratio monitoring. After a successful AF ablation, oral anticoagulation therapy discontinuation seems to be feasible in patients with a CHADS2 score greater than or equal to 2 and normal left atrial (LA) function. However, larger prospective randomized trials are needed to confirm the safety of this strategy.
Collapse
Affiliation(s)
- Antonio Rossillo
- Cardiovascular Department, Ospedale dell'Angelo, Mestre-Venice, Italy
| | | | | | | | | |
Collapse
|
31
|
Mangrolia N, Nayar V, Pugh PJ. Managing anticoagulation in patients receiving implantable cardiac devices. Future Cardiol 2012. [PMID: 26203472 DOI: 10.2217/fca.11.88] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
A substantial proportion of patients who undergo cardiac rhythm device implantation receive anticoagulation to prevent thromboembolism. Many patients have coexisting cardiovascular diseases treated with antiplatelet therapy. Anticoagulation may increase the risk of hemorrhagic complication, while withdrawal of anticoagulation may increase thromboembolic risk. In this article, we review and describe the available evidence, in order to inform best practice .
Collapse
Affiliation(s)
- Neil Mangrolia
- Box 263, Ward K2, Addenbrooke’s Hospital, Hills Road, Cambridge CB2 0QQ, UK
| | | | | |
Collapse
|
32
|
Bernard ML, Shotwell M, Nietert PJ, Gold MR. Meta-analysis of bleeding complications associated with cardiac rhythm device implantation. Circ Arrhythm Electrophysiol 2012; 5:468-74. [PMID: 22534249 DOI: 10.1161/circep.111.969105] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
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, aspirin only, AC held, AC continued, dual AP, and 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 of 5978 (4.6%), ranging from 2.2% (no therapy) 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 no therapy group. HBS significantly increased bleeding events compared with holding or continuing AC. Continuing AC did not increase bleeding events compared with no therapy. CONCLUSIONS Continuing AC appears safer than HBS for device implantation. Dual AP therapy but not continuing AC carries a significant risk of bleeding.
Collapse
Affiliation(s)
- Michael L Bernard
- Division of Cardiology, Medical University of South Carolina, Charleston, SC 29425, USA
| | | | | | | |
Collapse
|
33
|
BOULÉ STÉPHANE, MARQUIÉ CHRISTELLE, VANESSON-BRICOUT CLAIRE, KOUAKAM CLAUDE, BRIGADEAU FRANÇOIS, GUÉDON-MOREAU LAURENCE, ACHERÉ CHARLES, GOÉMINNE-BOULÉ CÉLINE, LACROIX DOMINIQUE, KLUG DIDIER, KACET SALEM. Clopidogrel Increases Bleeding Complications in Patients Undergoing Heart Rhythm Device Procedures. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2012; 35:605-11. [DOI: 10.1111/j.1540-8159.2012.03354.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
34
|
Korantzopoulos P, Letsas KP, Liu T, Fragakis N, Efremidis M, Goudevenos JA. Anticoagulation and antiplatelet therapy in implantation of electrophysiological devices. Europace 2011; 13:1669-1680. [PMID: 21788280 DOI: 10.1093/europace/eur210] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
|
35
|
[Antiplatelet agents increase hemorrhagic risk in patients undergoing a cardiac pacemaker or ICD implantation]. Ann Cardiol Angeiol (Paris) 2011; 60:267-71. [PMID: 21924701 DOI: 10.1016/j.ancard.2011.08.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2011] [Accepted: 08/04/2011] [Indexed: 11/22/2022]
Abstract
OBJECTIVES This study was designed to assess the hypothesis that the implantation or the replacement of a cardiac stimulator or defibrillator in patients receiving antiplatelet agents is associated with an increase of the haemorrhagic risk in comparison with patients not receiving antiplatelet agents (control group). METHODS AND RESULTS We retrospectively included all the patients undergoing pacemaker or ICD implantation or replacement between January 2007 and May 2010. The primary criterion was the incidence of bleeding complications. In our center, 685 patients were implanted in this period. Two hundred and fourteen (31%) were implanted while taking antiplatelet agents, including 164 (24%) taking aspirin, 31 (4%) taking clopidogrel and 19 (3%) taking the combination aspirin plus clopidogrel, while 471 patients (69%) did not receive antiplatelet agents. The primary criteria was the hemorrhagic complications. Complications were noted in 14 patients out of 471 (3%) not taking antiplatelet agents, in 16 patients out of 214 (7.5%) taking an antiplatelet agent (P=0.004). The complications concerned 13 patients out of 164 taking aspirin (7.9%), one patient out of 31 (3.2%) taking clopidogrel and two patients out of 19 taking the combination aspirin plus clopidogrel (10.5%) (P=0.042 for aspirin vs placebo, NS for all other comparisons). In multivariable analysis, the factors associated with an increase of the heamorrhagic complications were the type of implant (ICD) (OR 3,7; P=0.001) and antiplatelet treatment (OR 2,7; P=0.009). CONCLUSION Pacemaker and ICD implantation or replacement in patients taking antiplatelet agents are associated with an increase of the hemorrhagic risk.
Collapse
|
36
|
Lip GYH, Andreotti F, Fauchier L, Huber K, Hylek E, Knight E, Lane DA, Levi M, Marin F, Palareti G, Kirchhof P, Collet JP, Rubboli A, Poli D, Camm J. Bleeding risk assessment and management in atrial fibrillation patients: a position document from the European Heart Rhythm Association, endorsed by the European Society of Cardiology Working Group on Thrombosis. Europace 2011; 13:723-46. [PMID: 21515596 DOI: 10.1093/europace/eur126] [Citation(s) in RCA: 162] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Gregory Y H Lip
- University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham B18 7QH, UK.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Cheng A, Nazarian S, Brinker JA, Tompkins C, Spragg DD, Leng CT, Halperin H, Tandri H, Sinha SK, Marine JE, Calkins H, Tomaselli GF, Berger RD, Henrikson CA. Continuation of warfarin during pacemaker or implantable cardioverter-defibrillator implantation: A randomized clinical trial. Heart Rhythm 2011; 8:536-40. [DOI: 10.1016/j.hrthm.2010.12.016] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2010] [Accepted: 12/06/2010] [Indexed: 10/18/2022]
|
38
|
Li HK, Chen FC, Rea RF, Asirvatham SJ, Powell BD, Friedman PA, Shen WK, Brady PA, Bradley DJ, Lee HC, Hodge DO, Slusser JP, Hayes DL, Cha YM. No increased bleeding events with continuation of oral anticoagulation therapy for patients undergoing cardiac device procedure. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2011; 34:868-74. [PMID: 21410724 DOI: 10.1111/j.1540-8159.2011.03049.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Switching warfarin for heparin has been a practice for managing periprocedural anticoagulation in high-risk patients undergoing device-related procedures. We sought to investigate whether continuation of warfarin sodium therapy without heparin bridging is safe and, when it is continued, the optimal international normalized ratio (INR) without increased bleeding risk at time of device-related procedure. METHODS AND RESULTS We retrospectively studied 766 consecutive patients taking warfarin long term who underwent device-related procedures. Patients were grouped by treatment: discontinued warfarin (-warfarin, n = 243), no interruption of warfarin (+warfarin, n = 324), and discontinued warfarin with heparin bridging (+heparin, n = 199). The study primary endpoint was systemic bleeding or formation of moderate or severe pocket hematoma within 30 days of the procedure. Thirty-one (4%) patients had bleeding events, including pocket hematoma in 29 patients. The bleeding events occurred more often for +heparin (7.0%) than -warfarin (2.1%) or +warfarin (3.7%, P = 0.029). For +warfarin group, INR of 2.0-2.5 at time of procedure did not increase bleeding risk compared with INR less than 1.5 (3.7% vs 3.4%; P = 0.72), but INR greater than 2.5 increased the bleeding risk (10.0% vs 3.4%; P = 0.029). Concomitant aspirin use with warfarin significantly increased bleeding risk than warfarin alone (5.6% vs 1.4%, P = 0.02). Median length of hospitalization was significantly shorter for +warfarin than +heparin (1 vs 6 days; P < 0.001). CONCLUSION Continuation of oral anticoagulation therapy with an INR level of <2.5 does not impose increased risk of bleeding for device-related procedures, although precaution is necessary to avoid supratherapeutic anticoagulation levels.
Collapse
Affiliation(s)
- Hung-Kei Li
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota 55905, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Sohail MR, Hussain S, Le KY, Dib C, Lohse CM, Friedman PA, Hayes DL, Uslan DZ, Wilson WR, Steckelberg JM, Baddour LM. Risk factors associated with early- versus late-onset implantable cardioverter-defibrillator infections. J Interv Card Electrophysiol 2011; 31:171-83. [PMID: 21365264 DOI: 10.1007/s10840-010-9537-x] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2010] [Accepted: 12/21/2010] [Indexed: 12/19/2022]
Abstract
AIMS The infection rates of implantable cardioverter-defibrillators systems (ICDs) are higher than that of permanent pacemaker. Risk factors associated with ICD infection have not been characterized and are the subject of the current investigation. METHODS All patients who had an ICD implanted at Mayo Clinic Rochester between 1991 and 2008 were retrospectively reviewed. Each case of ICD infection was matched with two non-infected controls. Cases of ICD infection were further stratified by early- (≤ 6 months) versus late-onset (>6 months) infection. Multivariable analysis was performed to identify significant risk factors for ICD infection. RESULTS Sixty-eight patients with ICD infection and 136 matched controls met the inclusion criteria. Thirty-five cases presented with early-onset infection and 33 had late-onset device infection. Staphylococcal species were the most common pathogens in both groups of patients. Patients with early-onset infection were more likely to present with generator pocket infection (p = 0.02). Patients with multiple comorbid conditions (high Charlson index) tended to have longer hospital stay during implantation admission (p = 0.009). In a multivariable logistic regression model, the presence of epicardial leads (odds ratio (OR) = 9.7, p = 0.03) and postoperative complications at the generator pocket (OR = 27.2, p < 0.001) were significant risk factors for early-onset ICD infection, whereas longer duration of hospitalization at the time of implantation (2 days versus 1 day: OR = 33.1, p < 0.001; ≥ 3 days versus 1 day: OR = 49.0, p < 0.001) and chronic obstructive pulmonary disease (OR = 9.8, p = 0.02) were associated with late-onset infections. CONCLUSIONS Our study findings suggest that risk factors associated with early- and late-onset ICD infection are different. While circumstances that may increase the chances of pocket contamination in the perioperative period are more likely to be associated with early-onset ICD infection, overall poor health of the host may increase the likelihood of late-onset ICD infection. These factors should be considered when developing strategies to minimize risk of device infection.
Collapse
Affiliation(s)
- Muhammad R Sohail
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
40
|
|
41
|
Cano O, Osca J, Sancho-Tello MJ, Olagüe J, Castro JE, Salvador A. Morbidity associated with three different antiplatelet regimens in patients undergoing implantation of cardiac rhythm management devices. Europace 2010; 13:395-401. [PMID: 21131650 DOI: 10.1093/europace/euq431] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIMS Perioperative management of antiplatelet (AP) therapy in patients undergoing implantation of cardiac rhythm management devices (CRMD) remains an issue of concern that has not been prospectively evaluated in a large series. We sought to describe the morbidity associated with three different AP regimens in this setting. METHODS AND RESULTS We conducted a prospective observational study including 849 consecutive patients who were classified in three groups according to the presence of any AP treatment: Group 1 (n= 220): single AP therapy; Group 2 (n= 60): dual AP therapy; and Group 3 (n= 40): oral anticoagulant (OAC) + enoxaparin 'bridging' + AP therapy. Two other groups served as controls: Group 4 (n= 375): no AP or OAC therapy; and Group 5 (n= 154): OAC + enoxaparin 'bridging'. The incidence of pocket haematoma, pocket revisions, hospital stays duration, and unscheduled follow-up visits due to pocket-related complications were compared. Patients on Groups 2, 3 and 5 had significantly higher incidences of pocket haematoma (13.3, 15, and 14.9%, respectively) when compared with Groups 1 and 4 (3.2 and 2.4%, respectively), as well as longer hospital stays and more unscheduled follow-up visits. Of note, only patients on enoxaparin 'bridging' required surgical revision of the pocket. Dual AP therapy (P< 0.001), enoxaparin 'bridging' (P< 0.001) and renal insufficiency (P= 0.02) were independent predictors of pocket haematoma in multivariate analysis. CONCLUSION Dual AP therapy and OAC + AP therapy is strongly associated with a significant risk of pocket haematoma, longer hospital stays, and unscheduled follow-up visits. Importantly, surgical revision of the pocket was associated with enoxaparin 'bridging' strategy but was never necessary in patients taking exclusively antiaggregant agents.
Collapse
Affiliation(s)
- Oscar Cano
- Electrophysiology Section, Cardiology Department, Hospital Universitario La Fe, C/ Lope de Rueda, 48, 3, 46001 Valencia, Spain.
| | | | | | | | | | | |
Collapse
|
42
|
Bal S, Ojha P, Hill MD. Stroke prevention treatment of patients with atrial fibrillation: old and new. Curr Neurol Neurosci Rep 2010; 11:15-27. [PMID: 21086074 DOI: 10.1007/s11910-010-0161-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
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.
Collapse
Affiliation(s)
- Simerpreet Bal
- Departments of Clinical Neurosciences, Calgary Stroke Program, Faculty of Medicine, University of Calgary, Calgary, AB, Canada
| | | | | |
Collapse
|
43
|
Chronic kidney disease is an independent predictor of pocket hematoma after pacemaker and defibrillator implantation. J Interv Card Electrophysiol 2010; 29:203-7. [DOI: 10.1007/s10840-010-9520-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2010] [Accepted: 09/21/2010] [Indexed: 10/19/2022]
|