title: [Antiplatelet agents increase hemorrhagic risk in patients undergoing a cardiac pacemaker or ICD implantation].
abstract: OBJECTIVE
  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).
  
  
  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).
  
  
  CONCLUSIONS
  Pacemaker and ICD implantation or replacement in patients taking antiplatelet agents are associated with an increase of the hemorrhagic risk.
authors.affiliation: Unité de rythmologie, GHI Le Raincy-Montfermeil, France. walamara@yahoo.fr
authors.forename: W
authors.initials: W
authors.lastname: Amara
authors.forename: I
authors.initials: I
authors.lastname: Ben Youssef
authors.forename: F
authors.initials: F
authors.lastname: Monsel
authors.forename: J
authors.initials: J
authors.lastname: Sergent
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D001241:Aspirin / Q000008:administration & dosage / Q000009:adverse effects*; D000077144:Clopidogrel; D017147:Defibrillators, Implantable; D004359:Drug Therapy, Combination; D005602:France / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000706:statistics & numerical data; D008875:Middle Aged; D015999:Multivariate Analysis; D010138:Pacemaker, Artificial; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D011182:Postoperative Care / Q000379:methods; D019106:Postoperative Hemorrhage / Q000139:chemically induced* / Q000188:drug therapy / Q000453:epidemiology; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013988:Ticlopidine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin