BACKGROUND: Many patients requiring permanent pacemaker (PPM) or implantable cardiac defibrillator (ICD) placement had been taking warfarin, aspirin (ASA), or clopidogrel for a number of thromboembolic risk indications. Periprocedural management of antithrombotic therapy at the time of device implantation remains controversial. We assess the risk of significant bleeding complications in patients receiving antiplatelet agents or anticoagulants at the time of PPM implantation.METHODS: We performed a retrospective chart review of bleeding complications in all patients undergoing PPM implantation from October 1997 to May 2010. ASA or clopidogrel use was defined as taken within 5 days of the procedure. A significant bleeding complication was defined as need for pocket exploration or blood transfusion; hematoma requiring pressure dressing or change in antithrombotic therapy RESULTS: PPM implantations were performed in 164 men and 96 women. The mean age was 73±11years old. Fourteen patients were receiving periprocedural heparin infusion. (warfarin with changing to heparin at least 5 days before the procedure); 50 were on ASA, 4 on clopidogrel, and 25 of them on dual antiplatelet therapy (DAPT). Hematomas were occurred in eight patients (3.1%), all of them were receiving periprocedural heparin infusion after procedure (P < 0.0001). Pocket revision for hematoma evacuation was needed in four patients (1.5%). The use of periprocedural heparin markedly increased hospital stay when compared with patients without any drugs (10.36±.41 daysvs. 3.53±.2.28 days ; p=0.004). There were no significant differences in hospital stay between patients taking on aspirin or DAPT.CONCLUSIONS: This study suggests that hematoma formation after PPM implantation is rare, even among those who are taking DAPT. The pocket hematoma was frequently occurred in patients with receiving the intravenous heparin infusion after the procedure. Therefore, early use of periprocedural heparin infusion seems to significantly increase the risk of bleeding complications at the time of pacemaker implantation.
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