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Chronic kidney disease is an independent predictor of pocket hematoma after pacemaker and defibrillator implantation

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Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Introduction

The aim of this investigation was to determine additional predisposing factors of pocket hematoma formation in patients undergoing anti-arrhythmic device surgery.

Methods

Initially, we performed a retrospective chart review of 459 patients on warfarin therapy who underwent anti-arrhythmic device surgery (pacemaker or defibrillator implantation, generator replacement, or lead revision) between April 2004 and September 2008 to determine whether continuation of anticoagulation or cessation of anticoagulation, with or without bridging therapy, was the preferred approach. In those patients who developed pocket hematoma, we then analyzed factors that might predispose to hematoma formation.

Results

The incidence of pocket hematoma in the entire group was 2.2% (n = 10). Forty-eight percent of the patient group was on continued warfarin (n = 220), 27% on bridging therapy with intravenous heparin or subcutaneous enoxaparin (n = 123) and 66% were on antiplatelet therapy (aspirin or clopidegrol or both; n = 303) at the time of device implantation. Twelve percent of the patients had chronic kidney disease (n = 55). In multivariate regression analysis, after adjusting for anticoagulation and antiplatelet agents, chronic kidney disease was found to be a significant risk factor for pocket hematoma formation after ICD and pacemaker placement. An increase of 1.0 mg/dl in creatinine levels was associated with a nearly twofold increase in hematoma formation (OR, 1.99; 95% CI, 1.22–3.21; p = 0.03).

Conclusion

Chronic kidney disease is a significant risk factor for pocket hematoma formation after pacemaker and ICD placement, independent of anticoagulation and antiplatelet agents.

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Authors and Affiliations

  1. Section of Cardiology, Regions Hospital, 640 Jackson Street, St Paul, MN, 55101, USA

    William B. Nelson & Dennis W. X. Zhu

  2. Department of Medicine, Regions Hospital, 640 Jackson Street, St Paul, MN, 55101, USA

    Imdad Ahmed, Elie Gertner, William B. Nelson & Dennis W. X. Zhu

  3. University of Minnesota Medical School, Minneapolis, MN, 55455, USA

    Imdad Ahmed, Elie Gertner, William B. Nelson & Dennis W. X. Zhu

  4. Regions Hospital, 640 Jackson Street, St Paul, MN, 55101, USA

    Chad M. House

  5. Cardiology 11102H, Regions Hospital, 640 Jackson Street, St Paul, MN, 55101, USA

    Dennis W. X. Zhu

Authors
  1. Imdad Ahmed
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  2. Elie Gertner
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  3. William B. Nelson
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  4. Chad M. House
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  5. Dennis W. X. Zhu
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Corresponding author

Correspondence to Dennis W. X. Zhu.

Additional information

This work was supported in part by “Discovery Grants” from the HealthPartners Research Foundation, Minneapolis, Minnesota to Dr. Zhu and Dr. Ahmed. There is no financial relationship with HealthPartners Research Foundation. The authors have full control of all primary data and agree to allow the journal to review the data, if requested.

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Ahmed, I., Gertner, E., Nelson, W.B. et al. Chronic kidney disease is an independent predictor of pocket hematoma after pacemaker and defibrillator implantation. J Interv Card Electrophysiol 29, 203–207 (2010). https://doi.org/10.1007/s10840-010-9520-6

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  • DOI: https://doi.org/10.1007/s10840-010-9520-6

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