title: Peri-procedural anticoagulation and the incidence of haematoma formation after permanent pacemaker implantation in the elderly.
abstract: BACKGROUND
  Haematoma formation is a recognised complication after permanent pacemaker (PPM) implantation. The contribution of peri-procedural anticoagulation to the risk of haematoma formation is unclear.
  
  
  METHODS
  The records of 518 consecutive patients, mean age 76.9±9.8 years, receiving their first PPM (2004-2007) in a single tertiary referral centre were reviewed. Follow-up was complete for 506 patients (97.7%) up to six weeks. Haematomas were diagnosed clinically, and further subdivided according to the need for evacuation.
  
  
  RESULTS
  There were 27 instances of haematoma formation in 25 patients (4.9%) with 19 requiring drainage or evacuation. Twenty-one of the 25 patients who developed a haematoma had stopped warfarin and received bridging therapeutic anticoagulation pre- and post-PPM. The incidence of haematoma was significantly greater in those receiving peri-operative therapeutic anticoagulation (26.9% vs 0.9%, p<0.001), but was unaffected by the use of anti-platelet therapy. Most haematomas developed in patients whose heparin was recommenced within 24 hours of implantation. The development of haematoma post-PPM increased median hospital stay significantly (p<0.001). The main indication for anticoagulation in these patients was atrial fibrillation (79.5%) and most of these patients had a low to intermediate risk of peri-procedural thromboembolic events.
  
  
  CONCLUSIONS
  Peri-operative therapeutic anticoagulation is associated with more than 25-fold increase in haematoma formation post-pacemaker implantation. The risk-benefit ratio of therapeutic anticoagulation should be carefully considered, particularly in patients with a low risk of thromboembolic events.
authors.affiliation: Department of Cardiology, Concord Repatriation General Hospital, Hospital Road, Concord, NSW 2139, Australia.
authors.forename: Vincent
authors.initials: V
authors.lastname: Chow
authors.forename: Isuru
authors.initials: I
authors.lastname: Ranasinghe
authors.forename: Jerrett
authors.initials: J
authors.lastname: Lau
authors.forename: Hughina
authors.initials: H
authors.lastname: Stowe
authors.forename: Paul
authors.initials: P
authors.lastname: Bannon
authors.forename: Nick
authors.initials: N
authors.lastname: Hendel
authors.forename: Leonard
authors.initials: L
authors.lastname: Kritharides
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D005260:Female; D006406:Hematoma / Q000453:epidemiology* / Q000209:etiology; D006493:Heparin / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D008297:Male; D015999:Multivariate Analysis; D010138:Pacemaker, Artificial; D059035:Perioperative Period; D012189:Retrospective Studies; D012307:Risk Factors; D014859:Warfarin / Q000008:administration & dosage / Q000009:adverse effects
chemical_list: D000925:Anticoagulants; D014859:Warfarin; D006493:Heparin