title: Post-operative use of heparin increases morbidity of pacemaker implantation.
abstract: OBJECTIVE
  The objective of this study is to characterize the incidence of peri-operative severe adverse events (AEs) related to the post-operative use of heparin in patients undergoing pacemaker surgery.
  
  
  RESULTS
  We retrospectively compared the outcome of 38 patients with mechanical valves (MVs) and 76 patients with atrial fibrillation (AF) with control cases matched for gender, age, and surgical details. Heparin was systematically used post-operatively in MV patients, but left to clinical judgment in AF patients. The relative risk for severe haemorrhagic AEs was 11 (CI 1.5-81.1, P < 0.01) in the MV group when compared with matched controls and 8 (CI 1.0-62.5, P < 0.05) in the AF group. Overall, the relative risk of heparin use in the post-operative period was 14 (CI 1.88-104, P = 0.0006) and the post-operative stay was prolonged from 7 days in this group when compared with control cases (P < 0.0001).The variables associated with haemorrhage were the delay to restart heparin after surgery and the presence of an MV.
  
  
  CONCLUSIONS
  Post-operative use of heparin increases morbidity of pacemaker implantation. A different approach to management of these patients is possible.
authors.affiliation: CHRU, Cardiologie A, Cardiologic Hospital, bl du Pr, Lille 59037, France. c-marquie@chru-lille.fr
authors.forename: C
authors.initials: C
authors.lastname: Marquie
authors.forename: G
authors.initials: G
authors.lastname: De Geeter
authors.forename: D
authors.initials: D
authors.lastname: Klug
authors.forename: C
authors.initials: C
authors.lastname: Kouakam
authors.forename: F
authors.initials: F
authors.lastname: Brigadeau
authors.forename: O
authors.initials: O
authors.lastname: Jabourek
authors.forename: N
authors.initials: N
authors.lastname: Trillot
authors.forename: D
authors.initials: D
authors.lastname: Lacroix
authors.forename: S
authors.initials: S
authors.lastname: Kacet
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects; D001281:Atrial Fibrillation / Q000628:therapy*; D016022:Case-Control Studies; D005260:Female; D006350:Heart Valve Prosthesis; D006470:Hemorrhage / Q000453:epidemiology / Q000209:etiology*; D006493:Heparin / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D010138:Pacemaker, Artificial; D011184:Postoperative Period; D012189:Retrospective Studies
chemical_list: D000925:Anticoagulants; D006493:Heparin