Abstract | OBJECTIVES: BACKGROUND: Periprocedural management of antiplatelet or anticoagulation therapy at the time of device implantation remains controversial. METHODS: We performed a retrospective chart review of bleeding complications in all patients undergoing ICD or pacemaker implantation from August 2004 to August 2007. Aspirin 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 anticoagulation therapy; or prolonged hospitalization. RESULTS: Of the 1,388 device implantations, 71 had bleeding complications (5.1%). Compared with controls not taking antiplatelet agents (n = 255), the combination of aspirin and clopidogrel (n = 139) significantly increased bleeding risk (7.2% vs. 1.6%; p = 0.004). In patients taking aspirin alone (n = 536), bleeding risk was marginally higher than it was for patients taking no antiplatelet agents (3.9% vs. 1.6%, p = 0.078). The use of periprocedural heparin (n = 154) markedly increased risk of bleeding when compared with holding warfarin until the international normalized ratio (INR) was normal (n = 258; 14.3% vs. 4.3%; p < 0.001) and compared with patients receiving no anticoagulation therapy (14.3% vs.1.6%; p < 0.0001). There was no statistical difference in bleeding risk between patients continued on warfarin with an INR > or =1.5 (n = 46) and patients who had warfarin withheld until the INR was normal (n = 258; 6.5% vs. 4.3%; p = 0.50). CONCLUSIONS: Dual antiplatelet therapy and periprocedural heparin significantly increase the risk of bleeding complications at the time of pacemaker or ICD implantation.
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Authors | Christine Tompkins, Alan Cheng, Darshan Dalal, Jeffrey A Brinker, Charles T Leng, Joseph E Marine, Saman Nazarian, David D Spragg, Sunil Sinha, Henry Halperin, Gordon F Tomaselli, Ronald D Berger, Hugh Calkins, Charles A Henrikson |
Journal | Journal of the American College of Cardiology
(J Am Coll Cardiol)
Vol. 55
Issue 21
Pg. 2376-82
(May 25 2010)
ISSN: 1558-3597 [Electronic] United States |
PMID | 20488310
(Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)
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Copyright | Copyright (c) 2010 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. |
Chemical References |
- Platelet Aggregation Inhibitors
- Warfarin
- Heparin
- Clopidogrel
- Ticlopidine
- Aspirin
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Topics |
- Aged
- Aged, 80 and over
- Aspirin
(adverse effects, therapeutic use)
- Case-Control Studies
- Clopidogrel
- Confidence Intervals
- Defibrillators, Implantable
- Drug Therapy, Combination
- Female
- Follow-Up Studies
- Heparin
(adverse effects, therapeutic use)
- Humans
- Length of Stay
- Male
- Middle Aged
- Odds Ratio
- Pacemaker, Artificial
- Platelet Aggregation Inhibitors
(adverse effects, therapeutic use)
- Postoperative Care
(adverse effects, methods)
- Postoperative Hemorrhage
(epidemiology, etiology)
- Prevalence
- Reference Values
- Retrospective Studies
- Risk Assessment
- Ticlopidine
(adverse effects, analogs & derivatives, therapeutic use)
- Warfarin
(adverse effects, therapeutic use)
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