Please use this identifier to cite or link to this item: http://hdl.handle.net/1959.14/188924
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- Title
- Peri-procedural anticoagulation and the incidence of haematoma formation after permanent pacemaker implantation in the elderly
- Related
- Heart lung and circulation, Vol. 19, Issue 12, (2010), p.706-712
- DOI
- 10.1016/j.hlc.2010.08.011
- Publisher
- Elsevier Australia
- Date
- 2010
- FoR/RFCD Code(s)
-
111700 Public Health and Health Services
110200 Cardiovascular Medicine and Haematology
- Author/Creator
- Chow, Vincent
- Author/Creator
- Ranasinghe, Isuru
- Author/Creator
- Lau, Jerrett
- Author/Creator
- Stowe, Hughina
- Author/Creator
- Bannon, Paul
- Author/Creator
- Hendel, Nick
- Author/Creator
- Kritharides, Leonard
- Description
- Background - Haematoma formation is a recognised complication after permanent pacemaker (PPM) implantation. The contribution of peri-procedural anticoagulation to the risk of haematoma formation is unclear. Method - The records of 518 consecutive patients, mean age 76.9 ± 9.8 years, receiving their first PPM (2004–2007) in a single tertiary referral centre were reviewed. Follow-up was complete for 506 patients (97.7%) up to six weeks. Haematomas were diagnosed clinically, and further subdivided according to the need for evacuation. Results - There were 27 instances of haematoma formation in 25 patients (4.9%) with 19 requiring drainage or evacuation. Twenty-one of the 25 patients who developed a haematoma had stopped warfarin and received bridging therapeutic anticoagulation pre- and post-PPM. The incidence of haematoma was significantly greater in those receiving peri-operative therapeutic anticoagulation (26.9% vs 0.9%, p < 0.001), but was unaffected by the use of anti-platelet therapy. Most haematomas developed in patients whose heparin was recommenced within 24 hours of implantation. The development of haematoma post-PPM increased median hospital stay significantly (p < 0.001). The main indication for anticoagulation in these patients was atrial fibrillation (79.5%) and most of these patients had a low to intermediate risk of peri-procedural thromboembolic events. Conclusion - Peri-operative therapeutic anticoagulation is associated with more than 25-fold increase in haematoma formation post-pacemaker implantation. The risk-benefit ratio of therapeutic anticoagulation should be carefully considered, particularly in patients with a low risk of thromboembolic events.
- Description
- 7 page(s)
- Subject Keyword
- 111700 Public Health and Health Services
- Subject Keyword
- 110200 Cardiovascular Medicine and Haematology
- Subject Keyword
- Pacemaker
- Subject Keyword
- Haematoma
- Subject Keyword
- Complication
- Subject Keyword
- Anticoagulation
- Resource Type
- journal article
- Organisation
- Macquarie University. Australian School of Advanced Medicine
- Identifier
- http://hdl.handle.net/1959.14/188924
- Identifier
- ISSN:1328-0163
- Identifier
- mq-rm-2011003405
- Language
- eng
- Reviewed
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