Peri-procedural anticoagulation and the incidence of haematoma formation after permanent pacemaker implantation in the elderly.
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.
Chow
Vincent
V
Department of Cardiology, Concord Repatriation General Hospital, Hospital Road, Concord, NSW 2139, Australia.
Ranasinghe
Isuru
I
Lau
Jerrett
J
Stowe
Hughina
H
Bannon
Paul
P
Hendel
Nick
N
Kritharides
Leonard
L
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
D000925:Anticoagulants; D014859:Warfarin; D006493:Heparin