1
|
Mehta NK, Doerr K, Skipper A, Rojas-Pena E, Dixon S, Haines DE. Current strategies to minimize postoperative hematoma formation in patients undergoing cardiac implantable electronic device implantation: A review. Heart Rhythm 2020; 18:641-650. [PMID: 33242669 DOI: 10.1016/j.hrthm.2020.11.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 11/04/2020] [Accepted: 11/16/2020] [Indexed: 02/06/2023]
Abstract
There are an increasing number of cardiac electronic device implants and generator changes with a longer patient life expectancy along with concomitant increase in antiplatelet and anticoagulant regimens, which can increase the incidence of pocket hematomas. We have conducted an in-depth analysis on the relevant literature, which is rife with varying definition of hematomas, on ways to reduce pocket hematomas. We have analyzed studies on periprocedural medication management, intraprocedural use of prohemostatic agents, and postprocedure role of compression devices.
Collapse
Affiliation(s)
- Nishaki Kiran Mehta
- Department of Cardiovascular Medicine, Beaumont Hospital Royal Oak, Royal Oak, Michigan; Oakland University William Beaumont School of Medicine, Rochester, Michigan; Division of Cardiovascular Medicine, University of Virginia, Charlottesville, Virginia.
| | - Kimberly Doerr
- Oakland University William Beaumont School of Medicine, Rochester, Michigan
| | - Andrew Skipper
- Oakland University William Beaumont School of Medicine, Rochester, Michigan
| | - Edward Rojas-Pena
- Oakland University William Beaumont School of Medicine, Rochester, Michigan
| | - Simon Dixon
- Department of Cardiovascular Medicine, Beaumont Hospital Royal Oak, Royal Oak, Michigan; Division of Cardiovascular Medicine, University of Virginia, Charlottesville, Virginia
| | - David E Haines
- Department of Cardiovascular Medicine, Beaumont Hospital Royal Oak, Royal Oak, Michigan; Division of Cardiovascular Medicine, University of Virginia, Charlottesville, Virginia
| |
Collapse
|
2
|
Fischer K, Bodalbhai F, Awudi E, Surani S. Reversing Bleeding Associated With Antiplatelet Use: The Role of Tranexamic Acid. Cureus 2020; 12:e10290. [PMID: 33047080 PMCID: PMC7540200 DOI: 10.7759/cureus.10290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 09/07/2020] [Indexed: 11/17/2022] Open
Abstract
Dual antiplatelet therapy (DAPT) is the mainstay of therapy in patients that have been diagnosed with coronary artery disease. DAPT has known risk factors such as an increased risk of bleeding, and, currently, no specific medication is indicated to reverse bleeding associated with antiplatelet use. One medication that may help reduce blood loss is tranexamic acid (TXA). A retrospective review of the literature regarding TXA in the setting of antiplatelet associated bleeding through a systematic search strategy was conducted. This review of the literature followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines and included seven studies. Multiple studies demonstrated the impact on platelet function resulting from administering TXA through lower volumes of blood loss, lower transfusion requirements, and lower incidence of reoperations. TXA is not widely recommended to reverse antiplatelet medications; however, it is widely available, has a positive track record for use in various types of bleeding, and is relatively inexpensive and safe. Large-scale randomized trials are warranted to make a strong recommendation for TXA in reversing bleeding associated with antiplatelet therapy.
Collapse
Affiliation(s)
- Kyle Fischer
- Pharmacy, Texas A&M Irma Lerma Rangel College of Pharmacy, Kingsville, USA
| | - Fatema Bodalbhai
- Pharmacy, Texas A&M Irma Lerma Rangel College of Pharmacy, College Station, USA
| | - Elizabeth Awudi
- Pharmacy, Corpus Christi Medical Center, Corpus Christi, USA
| | - Salim Surani
- Internal Medicine, Corpus Christi Medical Center, Corpus Christi, USA
- Internal Medicine, University of North Texas, Dallas, USA
| |
Collapse
|
3
|
Barbar T, Patel R, Thomas G, Cheung JW. Strategies to Prevent Cardiac Implantable Electronic Device Infection. J Innov Card Rhythm Manag 2020; 11:3949-3956. [PMID: 32368364 PMCID: PMC7192142 DOI: 10.19102/icrm.2020.110102] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Accepted: 10/16/2019] [Indexed: 12/15/2022] Open
Abstract
The association between the risk of mortality and cardiovascular implantable electronic device (CIED) infections has been well-established in the literature. As CIED implantations have increased in frequency in the past few decades, the incidence of CIED-related infections has also risen. Given the morbidity, mortality, and health-care costs associated with CIED infections, the prevention of device-related infection is a critical goal. Risk factors for developing CIED infections can be categorized as patient-, procedure-, or device-related. Numerous studies have highlighted different strategies for preventing CIED-related infections, which include patient optimization, device selection, and periprocedural preparation and treatment. Nonetheless, as the comorbidity burden of patients undergoing CIED implantation continues to increase, significant challenges in the successful elimination of CIED-related infections remain. This review provides a comprehensive overview of available evidence-based approaches and strategies to reduce the risk of CIED infections.
Collapse
Affiliation(s)
- Tarek Barbar
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine-New York Presbyterian Hospital, New York, NY, USA
| | - Rohan Patel
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine-New York Presbyterian Hospital, New York, NY, USA
| | - George Thomas
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine-New York Presbyterian Hospital, New York, NY, USA
| | - Jim W Cheung
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine-New York Presbyterian Hospital, New York, NY, USA
| |
Collapse
|
4
|
Essebag V, Healey JS, Joza J, Nery PB, Kalfon E, Leiria TLL, Verma A, Ayala-Paredes F, Coutu B, Sumner GL, Becker G, Philippon F, Eikelboom J, Sandhu RK, Sapp J, Leather R, Yung D, Thibault B, Simpson CS, Ahmad K, Toal S, Sturmer M, Kavanagh K, Crystal E, Wells GA, Krahn AD, Birnie DH. Effect of Direct Oral Anticoagulants, Warfarin, and Antiplatelet Agents on Risk of Device Pocket Hematoma: Combined Analysis of BRUISE CONTROL 1 and 2. Circ Arrhythm Electrophysiol 2019; 12:e007545. [PMID: 31610718 DOI: 10.1161/circep.119.007545] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Oral anticoagulant use is common among patients undergoing pacemaker or defibrillator surgery. BRUISE CONTROL (Bridge or Continue Coumadin for Device Surgery Randomized Controlled Trial; NCT00800137) demonstrated that perioperative warfarin continuation reduced clinically significant hematomas (CSH) by 80% compared with heparin bridging (3.5% versus 16%). BRUISE-CONTROL-2 (NCT01675076) observed a similarly low risk of CSH when comparing continued versus interrupted direct oral anticoagulant (2.1% in both groups). Using patient level data from both trials, the current study aims to: (1) evaluate the effect of concomitant antiplatelet therapy on CSH, and (2) understand the relative risk of CSH in patients treated with direct oral anticoagulant versus continued warfarin. METHODS We analyzed 1343 patients included in BRUISE-CONTROL-1 and BRUISE-CONTROL-2. The primary outcome for both trials was CSH. There were 408 patients identified as having continued either a single or dual antiplatelet agent at the time of device surgery. RESULTS Antiplatelet use (versus nonuse) was associated with CSH in 9.8% versus 4.3% of patients (P<0.001), and remained a strong independent predictor after multivariable adjustment (odds ratio, 1.965; 95% CI, 1.202-3.213; P=0.0071). In multivariable analysis, adjusting for antiplatelet use, there was no significant difference in CSH observed between direct oral anticoagulant use compared with continued warfarin (odds ratio, 0.858; 95% CI, 0.375-1.963; P=0.717). CONCLUSIONS Concomitant antiplatelet therapy doubled the risk of CSH during device surgery. No difference in CSH was found between direct oral anticoagulant versus continued warfarin. In anticoagulated patients undergoing elective or semi-urgent device surgery, the patient specific benefit/risk of holding an antiplatelet should be carefully considered. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifiers: NCT00800137, NCT01675076.
Collapse
Affiliation(s)
- Vidal Essebag
- McGill University, McGill University Health Centre and Hôpital Sacré-Coeur de Montréal, QC, Canada (V.E.)
| | - Jeff S Healey
- McMaster University, Hamilton Health Sciences, Population Health Research Institute, Hamilton, ON, Canada (J.S.H., J.E.,)
| | - Jacqueline Joza
- McGill University, McGill University Health Centre, Montreal, QC, Canada (J.J.)
| | - Pablo B Nery
- Department of Medicine, University of Ottawa, University of Ottawa Heart Institute, ON, Canada (P.B.N., G.A.W., D.H.B.)
| | - Eli Kalfon
- Galilee Medical Centre, Naharyia, Israel (E.K.)
| | - Tiago L L Leiria
- Instituto de Cardiologia, Fundacao Universidade de Cardiologia, Porte Alegre, RS, Brazil (T.L.L.L)
| | - Atul Verma
- Southlake Regional Health Centre, Newmarket, ON, Canada (A.V.)
| | | | - Benoit Coutu
- Centre Hospitalier de L'Université de Montreal, Hopital Hotel-Dieu, QC, Canada (B.C.)
| | - Glen L Sumner
- University of Calgary, Libin Cardiovascular Institute, Foothills Medical Centre, AB, Canada (G.L.S., K.K.)
| | | | | | - John Eikelboom
- McMaster University, Hamilton Health Sciences, Population Health Research Institute, Hamilton, ON, Canada (J.S.H., J.E.,)
| | | | - John Sapp
- Dalhousie University, QEII Health Sciences Centre, Halifax, NS, Canada (J.S.)
| | - Richard Leather
- Department of Medicine, University of British Columbia, Vancouver, Canada (R.L.)
| | - Derek Yung
- Scarborough Health Network, University of Toronto, Clinical Adjunct, ON, Canada (D.Y.)
| | - Bernard Thibault
- Montreal Heart Institute, Université de Montreal, QC, Canada (B.T.)
| | | | - Kamran Ahmad
- University of Toronto, St Michael's Hospital, ON, Canada (K.A.)
| | - Satish Toal
- Saint John Regional Hospital, NB, Canada (S.T.)
| | - Marcio Sturmer
- Hôpital du Sacré-Coeur de Montréal, QC, Canada (G.B., M.S.)
| | - Katherine Kavanagh
- University of Calgary, Libin Cardiovascular Institute, Foothills Medical Centre, AB, Canada (G.L.S., K.K.)
| | - Eugene Crystal
- Arrhythmia Services, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, ON, Canada (E.C.)
| | - George A Wells
- Department of Medicine, University of Ottawa, University of Ottawa Heart Institute, ON, Canada (P.B.N., G.A.W., D.H.B.)
| | - Andrew D Krahn
- University of British Columbia, Vancouver, Canada (A.D.K.)
| | - David H Birnie
- Department of Medicine, University of Ottawa, University of Ottawa Heart Institute, ON, Canada (P.B.N., G.A.W., D.H.B.)
| |
Collapse
|