Relationship between antithrombotic treatmen in the peri-procedural period and the incidence of hematoma after device implantation

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Objective To evaluate the suitable strategies of antithrombotic therapy for patients with cardiovascular implantable electronic devices(CIED)in the peri-procedure period. Methods Clinical characteristics and anticoagulant/antiplatelet drugs in 350 patients[age, 23-95(68.3±13.1)years; males 57.7%]implanted with CIED were evaluated and analyzed retrospectively. Results There were 27 cases(7.7%)who continued the warfarin during peri-operation, 61 cases(17.4%)bridged with low-molecular-weight heparin(LMWH), 17 cases(4.9%)continued aspirin(ASA), 24 cases(6.9%)continued aspirin plus clopidogrel, 221 cases(63.1%)interrupted antithrombotic drugs more than 7 days or didn't use the drugs which might affect blood coagulation function.Of these, 6 patients(1.7%)experienced a hematoma at pacemaker pocket and needed hematoma evacuation, four of them were to bridge LMWH.The frequency of hematoma was significantly higher(P=0.008)in patients who bridged to LMWH.ASA alone, dual antiplatelet(DAP)therapy, and warfarin did not increase the risk of hematoma(P>0.1). The body mass index(BMI)in the patients with hematoma was less than that in patients without hematoma[(19.6±2.3)vs.(23.2±2.2), P=0.033)]. Heart failure increased the risk of bleeding(66.7% vs.7.6%, P<0.001). Logistic regression analysis model was established and showed that hematoma was increased by 3.39(95% CI 3.39-1.84)times in the bridging therapy group, and 4.32(95% CI, 4.32~1.83)in patients with a low BMI. Conclusion ①Warfarin, aspirin or DAP shouldn’t be interrupted before the CIED implantation.②Bridging by LMWH should be abandoned because it could increase the risk of hematoma seriously in the peri-procedure period.③Patient might associate with a higher risk of perioperative thromboembolic events during anticoagulant therapy interruption.④Patients with emaciation or heart failure might suffer high risk of hematoma. Key words: Pacemaker implantation; Antithrombotics; Hematoma