title: Incidence of pocket hematoma after electrophysiological device placement: dual antiplatelet therapy versus low-molecular-weight heparin regimen.
abstract: BACKGROUND
  Given the increasing number of patients who require dual antiplatelet (DAP) therapy and electrophysiological device (EPD) placement, perioperative antiplatelet management is a current challenge. In this study, we investigated the incidence of pocket hematoma formation after EPD placement in patients undergoing DAP therapy or an alternative low-molecular-weight heparin (LMWH) regimen.
  
  
  METHODS
  This clinical observational study was performed from July 2010 to July 2012. In total, 171 patients were enrolled in the analysis after meeting the inclusion criteria. These patients were divided into two groups: 86 patients were treated with DAP therapy at the time of device implantation, and the DAP therapy was discontinued for 5 to 7 days and replaced with enoxaparin before device implantation in the other 85 patients. Adenosine phosphate (ADP)-mediated platelet aggregation and arachidonic acid-induced platelet aggregation were tested preoperatively. We compared the incidence of pocket hematoma between the two groups and the association of pocket hematoma development with ADP-mediated platelet aggregation and arachidonic acid-induced platelet aggregation.
  
  
  RESULTS
  The incidence of pocket hematoma in the patients who continued DAP was lower than that in the patients who replaced the dual antiplatelet regimen with LMWH (3.49% vs. 16.47%, respectively; X (2) = 6.66, P < 0.01). Among the patients who continued DAP therapies, the rate of ADP-mediated platelet aggregation inhibition in patients with pocket hematomas was higher than that in patients without pocket hematomas. None of the patients undergoing DAP or enoxaparin therapy developed pocket infection, thromboembolic events, or other serious complications. Multiple logistic regression analysis revealed that LMWH therapy was an independent risk factor for the development of pocket hematoma (RR = 0.054, 95%CI = 0.012-0.251). Furthermore, patients undergoing LMWH therapy were 5.1-fold more likely to develop pocket hematomas than were DAP-treated individuals.
  
  
  CONCLUSIONS
  Continuance of DAP therapy does not increase the risk of pocket hematoma formation after EPD placement.
authors.affiliation: Department of Cardiology, Tianjin Chest Hospital, Tianjin 300200, China ; Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Chen
authors.affiliation: Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China.
authors.forename: Yun-Tao
authors.initials: YT
authors.lastname: Li
authors.affiliation: Department of Cardiology, Tianjin Chest Hospital, Tianjin 300200, China.
authors.forename: Ming-Dong
authors.initials: MD
authors.lastname: Gao
authors.affiliation: Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China.
authors.forename: Ze-Chun
authors.initials: ZC
authors.lastname: Zeng
authors.affiliation: Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China.
authors.forename: Jin-Rong
authors.initials: JR
authors.lastname: Zhang
authors.affiliation: Department of Cardiology, Tianjin Chest Hospital, Tianjin 300200, China.
authors.forename: Hong-Liang
authors.initials: HL
authors.lastname: Cong
authors.affiliation: Department of Cardiology, Tianjin Chest Hospital, Tianjin 300200, China.
authors.forename: Yin
authors.initials: Y
authors.lastname: Liu
authors.affiliation: Department of Cardiology, Tianjin Chest Hospital, Tianjin 300200, China.
authors.forename: Ru
authors.initials: R
authors.lastname: Zhao
authors.affiliation: Department of Cardiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China.
authors.forename: Le-Feng
authors.initials: LF
authors.lastname: Wang
authors.affiliation: Department of Cardiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China.
authors.forename: Xin-Cun
authors.initials: XC
authors.lastname: Yang
authors.affiliation: Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China.
authors.forename: Kang
authors.initials: K
authors.lastname: Meng
keywords: Antiplatelet drug; Electrophysiological device; Hematoma; Low-molecular-weight heparin