PMID- 29659027
OWN - NLM
STAT- MEDLINE
DCOM- 20191212
LR  - 20220409
IS  - 1540-8159 (Electronic)
IS  - 0147-8389 (Linking)
VI  - 41
IP  - 7
DP  - 2018 Jul
TI  - Perioperative hematoma with subcutaneous ICD implantation: Impact of 
      anticoagulation and antiplatelet therapies.
PG  - 799-806
LID - 10.1111/pace.13349 [doi]
AB  - BACKGROUND: The safety of perioperative anticoagulation (AC) and antiplatelet 
      (AP) therapy with subcutaneous implantable cardioverter-defibrillator (S-ICD) 
      implantation is unknown. The purpose of this study was to identify the risk 
      factors associated with hematoma complicating S-ICD implantation. METHODS: 
      Records were retrospectively reviewed from 200 consecutive patients undergoing 
      S-ICD implantation at two academic medical centers. A hematoma was defined as a 
      device site blood accumulation requiring surgical evacuation, extended hospital 
      stay, or transfusion. RESULTS: Among 200 patients undergoing S-ICD implantation 
      (age 49 +/- 17 years, 67% men), 10 patients (5%) had a hematoma, which required 
      evacuation in six patients (3%). Warfarin was bridged or uninterrupted in 12 and 
      13 patients, respectively (6% and 6.5%). Four of 12 patients with warfarin and 
      bridging AC (33%) and two of 13 patients with uninterrupted warfarin (15%) 
      developed a hematoma. Neither of the two patients with uninterrupted DOAC had a 
      hematoma. No patients on interrupted AC without bridging (n = 26, 13 with 
      warfarin, 13 with DOAC) developed a hematoma. A hematoma was also more likely 
      with the use of clopidogrel (n = 4/10 vs 10/190, 40% vs 5.3%, P < 0.0001) in 
      combination with aspirin in 12/14 patients. Any bridging AC (odds ratio [OR] 
      10.3, 1.8-60.8, P = 0.01), clopidogrel (OR 10.0, 1.7-57.7, P = 0.01), and 
      uninterrupted warfarin without bridging (OR 11.1, 1.7-74.3, P = 0.013) were 
      independently associated with hematoma formation. CONCLUSION: AC and/or AP 
      therapy with clopidogrel appears to increase the risk for hematoma following 
      S-ICD implantation. Interruption of AC without bridging should be considered when 
      it is an acceptable risk to hold AC.
CI  - (c) 2018 Wiley Periodicals, Inc.
FAU - Sheldon, Seth H
AU  - Sheldon SH
AUID- ORCID: 0000-0003-0543-2040
AD  - Division of Cardiovascular Diseases, University of Kansas Medical Center, Kansas 
      City, KS, USA.
FAU - Cunnane, Ryan
AU  - Cunnane R
AD  - Division of Cardiovascular Diseases, University of Michigan, Ann Arbor, MI, USA.
FAU - Lavu, Madhav
AU  - Lavu M
AUID- ORCID: 0000-0002-6145-9902
AD  - Division of Cardiovascular Diseases, University of Kansas Medical Center, Kansas 
      City, KS, USA.
FAU - Parikh, Valay
AU  - Parikh V
AD  - Division of Cardiovascular Diseases, University of Kansas Medical Center, Kansas 
      City, KS, USA.
FAU - Atkins, Donita
AU  - Atkins D
AD  - Division of Cardiovascular Diseases, University of Kansas Medical Center, Kansas 
      City, KS, USA.
FAU - Reddy, Yeruva Madhu
AU  - Reddy YM
AD  - Division of Cardiovascular Diseases, University of Kansas Medical Center, Kansas 
      City, KS, USA.
FAU - Berenbom, Loren D
AU  - Berenbom LD
AD  - Division of Cardiovascular Diseases, University of Kansas Medical Center, Kansas 
      City, KS, USA.
FAU - Emert, Martin P
AU  - Emert MP
AD  - Division of Cardiovascular Diseases, University of Kansas Medical Center, Kansas 
      City, KS, USA.
FAU - Pimentel, Rhea
AU  - Pimentel R
AD  - Division of Cardiovascular Diseases, University of Kansas Medical Center, Kansas 
      City, KS, USA.
FAU - Dendi, Raghuveer
AU  - Dendi R
AD  - Division of Cardiovascular Diseases, University of Kansas Medical Center, Kansas 
      City, KS, USA.
FAU - Lakkireddy, Dhanunjaya R
AU  - Lakkireddy DR
AUID- ORCID: 0000-0002-1492-2693
AD  - Division of Cardiovascular Diseases, University of Kansas Medical Center, Kansas 
      City, KS, USA.
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
DEP - 20180522
PL  - United States
TA  - Pacing Clin Electrophysiol
JT  - Pacing and clinical electrophysiology : PACE
JID - 7803944
RN  - 0 (Anticoagulants)
RN  - 0 (Platelet Aggregation Inhibitors)
RN  - 5Q7ZVV76EI (Warfarin)
RN  - A74586SNO7 (Clopidogrel)
RN  - R16CO5Y76E (Aspirin)
SB  - IM
MH  - Anticoagulants/*adverse effects
MH  - Aspirin/*adverse effects
MH  - Clopidogrel/*adverse effects
MH  - *Defibrillators, Implantable
MH  - Female
MH  - Hematoma/*chemically induced/*epidemiology
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Platelet Aggregation Inhibitors/*adverse effects
MH  - Postoperative Complications/*chemically induced/*epidemiology
MH  - Prosthesis Implantation/methods
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Warfarin/*adverse effects
OTO - NOTNLM
OT  - anticoagulation
OT  - antiplatelet therapy
OT  - direct oral anticoagulant
OT  - hematoma
OT  - subcutaneous implantable cardioverter-defibrillator
EDAT- 2018/04/17 06:00
MHDA- 2019/12/18 06:00
CRDT- 2018/04/17 06:00
PHST- 2018/01/24 00:00 [received]
PHST- 2018/03/05 00:00 [revised]
PHST- 2018/03/25 00:00 [accepted]
PHST- 2018/04/17 06:00 [pubmed]
PHST- 2019/12/18 06:00 [medline]
PHST- 2018/04/17 06:00 [entrez]
AID - 10.1111/pace.13349 [doi]
PST - ppublish
SO  - Pacing Clin Electrophysiol. 2018 Jul;41(7):799-806. doi: 10.1111/pace.13349. Epub 
      2018 May 22.