title: Influence of oral antiplatelet therapy on hemorrhagic complications of pacemaker implantation.
abstract: OBJECTIVE
  We retrospectively assessed the incidence of hemorrhagic complications associated with pacemaker implantation in patients receiving one or more antiplatelet agents.
  
  
  METHODS
  Retrospective multicenter case-control study. Data were collected from three cardiac units in Germany from 2006 to 2010.
  
  
  METHODS
  A total of 495 pacemaker patients were enrolled. 99 patients received dual antiplatelet therapy (aspirin and clopidogrel), 198 were given only aspirin and 198 had no antiplatelet therapy (control). Patients were matched for age and sex. Implant-related bleeding complications were defined as major bleeding, if surgical pocket exploration or blood transfusion were needed. Minor bleeding complications were defined as one or more of the following conditions: fall of hemoglobin content >1.5 g/dl not requiring blood transfusion; pocket hematoma; pocket effusion not requiring surgical revision.
  
  
  RESULTS
  Hemorrhagic complications were seen in 4/198 control patients and 6/198 aspirin-only patients [2 vs. 3 %, p = 0.5, OR = 1.52 (0.42-5.46)]. Patients undergoing dual antiplatelet therapy had significantly more bleeding complications than patients in the aspirin-only group [11/99: 11.1 vs. 3 %, p = 0.005, OR = 3.95 (1.43-11.16)]. Major complications occurred in 1/198 control patients and 2/198 aspirin-only patients [0.5 vs. 1 %, p = 0.6, OR = 2.01 (0.18-22.35)]. In contrast, 7/99 patients undergoing dual antiplatelet therapy exhibited major complications [7.1 vs. 1 %, p = 0.004, OR = 7.46 (1.52-36.50)].
  
  
  CONCLUSIONS
  Although in patients undergoing pacemaker implantation dual antiplatelet therapy with aspirin and clopidogrel caused a significant increase of bleeding complications, the use of aspirin alone was not associated with a significant increase in bleeding complications.
authors: Division of Cardiology, Centre of Internal Medicine, University Hospital Magdeburg, Otto-von-Guericke University, Leipziger Str. 44, 39120 Magdeburg, Germany. samir.said@med.ovgu.de
authors: Samir M
authors: SM
authors: Said
authors: Hans D
authors: HD
authors: Esperer
authors: Judit
authors: J
authors: Hahn
authors: Andreas
authors: A
authors: Bollmann
authors: Sergio
authors: S
authors: Richter
authors: Thomas
authors: T
authors: Rauwolf
authors: Roland
authors: R
authors: Prondzinsky
authors: Alexander
authors: A
authors: Schmeisser
authors: Ruediger C
authors: RC
authors: Braun-Dullaeus
mesh_terms: D000284:Administration, Oral; D000368:Aged; D001241:Aspirin / Q000008:administration & dosage / Q000009:adverse effects*; D015415:Biomarkers / Q000097:blood; D001803:Blood Transfusion; D002304:Cardiac Pacing, Artificial; D000077144:Clopidogrel; D004359:Drug Therapy, Combination; D005260:Female; D005858:Germany / Q000453:epidemiology; D006406:Hematoma / Q000139:chemically induced / Q000453:epidemiology; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010138:Pacemaker, Artificial; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D019106:Postoperative Hemorrhage / Q000097:blood / Q000139:chemically induced* / Q000453:epidemiology / Q000601:surgery; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013988:Ticlopidine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D006454:Hemoglobins; D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin
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