Clinical characteristics and management strategies of delayed pocket hematoma in patients with cardiac implantable electronic devices which caused by oral anticoagulant

Abstract

Objective To investigate the clinical features and management strategies of delayed hematoma in cardiac implantable electronic devices (CIED) patients which caused by oral anticoagulant drugs. Methods Retrospective analysis of 841 patients with CIED from January 2017 to July 2018 in Xiangya Second Hospital and Xiangya Third Hospital. Delayed pocket hematoma was defined by a pocket hematoma occurred at least 5 days after the device implantation, clinical data, and its treatment strategy were collected and analyzed. Results In the follow-up period of (12.0±8.8) months after implantation, 9 cases of pocket hematoma occurred, which the incidence rate of was 1.1%. Five cases of delayed pocket hematoma occurred, which the occurred incidence rate of was 0.6%. Two cases were healing after pressure-wrapped and conservative treatment. Two patients recovered after hematoma evacuation. One patient with hematoma aspiration and conservative treatment developed pocket rupture and infection in the later stage. He recovered after the device was removed and re-implanted. There was no death. There is not any statistics analysis because of small size of patients. Delayed hematoma is characterized by often occurring in patients receiving anticoagulant therapy, no obvious systemic or local inflammatory response, pocket effusion microscopic examination and culture without bacterial detection, without local tissue inflammatory damage, hemorrhage or the effusion was quickly absorbed after conservative treatment. Conclusion There is a certain incidence of delayed hematoma after CIED implantation. It is primarily related to the use of anticoagulant drugs, especially non-standardized use. According to its clinical features, it can be differentiated from infectious effusion, and it can be treated by hematoma evacuation or conservative treatment. Key words: Postoperative complications; Cardiac implantable electronic devices; Hematoma