[Safety of device implantation under antipatelet therapy with ticagrelor: About 20 cases].
BACKGROUND
Management of antiplatelet therapy at the time of device implantation remains controversial. This study aimed to assess the risk of bleeding complications in patients receiving ticagrelor at the time of cardiac device surgery.


METHODS
We performed a multicentre (n=4), retrospective study from January 2015 to January 2016. The survey included all patients (pts) treated with ticagrelor before undergoing pacemaker, implantable cardioverter-defibrillator (ICD) implantation or generator replacement. We report hemorrhagic post-procedural complications at 1 month. A significant bleeding complication was defined as pocket hematoma requiring a surgical evacuation or prolonged hospitalization, hemothorax, pericardial effusion, or tamponade.


RESULTS
A total of 20 patients underwent a permanent pacemaker or ICD implantation while taking a combination of antipatelet therapy with ticagrelor and aspirin. The mean age of the patients was 65±9 years, 95% were male, 25% of patients were diabetics, 55% had hypertension and 50% presented a history of heart failure. All the patients had a history of acute coronary syndrome [6 (4-26) months before the procedure]. The majority of implanted devices were ICDs (17, 85%) with 5 single chamber, 4 dual chambers and 9 triple chambers ICDs. Subclavian venous approach was utilized in 9 patients. The mean duration of procedure was 60minutes. One per-procedure bleeding was described due to high venous pressure, without post-procedure hematoma. A post-procedure pocket hematoma has been experienced by one patient. The subclavian approach was used for the 2 patients. No blood transfusion was needed for these 2 cases.


CONCLUSIONS
Ticagrelor treatment at the time of heart rhythm device procedures does not seem to be associated with an increased risk of significant bleeding complications. In our study, 2 patients experienced nonsignificant bleeding complications.
Unité de rythmologie, GHI Le Raincy-Montfermeil, 10, rue du Général-Leclerc, 93370 Montfermeil, France. Electronic address: walamara@yahoo.fr.
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Amara
Unité de rythmologie, GHI Le Raincy-Montfermeil, 10, rue du Général-Leclerc, 93370 Montfermeil, France.
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Naccache
Centre hospitalier Annecy-Genevois, 1, avenue de l'Hôpital, 74370 Epagny Metz-Tessy, France.
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Akret
Centre hospitalier d'Avignon, 305, rue Raoul-Follereau, 84000 Avignon, France.
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Cheggour
Centre hospitalier d'Avignon, 305, rue Raoul-Follereau, 84000 Avignon, France.
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M'Zoughi
Centre hospitalier André-Mignot, 177, rue de Versailles, 78150 Le Chesnay, France.
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Galuscan
Centre hospitalier Annecy-Genevois, 1, avenue de l'Hôpital, 74370 Epagny Metz-Tessy, France.
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Dompnier
D000241:Adenosine / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000368:Aged; D002305:Cardiac Tamponade / Q000139:chemically induced; D017147:Defibrillators, Implantable; D005260:Female; D006491:Hemothorax / Q000139:chemically induced; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D010490:Pericardial Effusion / Q000139:chemically induced; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D019106:Postoperative Hemorrhage / Q000139:chemically induced*; D012189:Retrospective Studies; D012307:Risk Factors; D000077486:Ticagrelor
D010975:Platelet Aggregation Inhibitors; D000077486:Ticagrelor; D000241:Adenosine
Complication; Complications; Défibrillateur; Hematoma; Hématome; ICD; Pacemaker; Ticagrelor