Author + information
- Received July 24, 2009
- Revision received December 16, 2009
- Accepted December 21, 2009
- Published online May 25, 2010.
- Christine Tompkins, MD, MS,
- Alan Cheng, MD,
- Darshan Dalal, MBBS, PhD, MPH,
- Jeffrey A. Brinker, MD,
- Charles T. Leng, MD,
- Joseph E. Marine, MD,
- Saman Nazarian, MD,
- David D. Spragg, MD,
- Sunil Sinha, MD,
- Henry Halperin, MD, MA,
- Gordon F. Tomaselli, MD,
- Ronald D. Berger, MD, PhD,
- Hugh Calkins, MD and
- Charles A. Henrikson, MD, MPH⁎ ()
- ↵⁎Reprint requests and correspondence:
Dr. Charles Henrikson, Johns Hopkins Hospital, Electrophysiology, 600 North Wolfe Street, Carnegie 592, Baltimore, Maryland 21287
Objectives This study was designed to assess the risk of significant bleeding complications in patients receiving antiplatelet or anticoagulation medications at the time of implantable cardioverter-defibrillator (ICD) device implantation.
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 ≥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.
Dr. Cheng has received a research grant from Boston Scientificand honoraria from Medtronic and Boston Scientific. Dr. Spragg has received speaking fees from Medtronic and grant support from Boston Scientific. Dr. Tomaselli has received a research grant from Boston Scientific.
- Received July 24, 2009.
- Revision received December 16, 2009.
- Accepted December 21, 2009.
- American College of Cardiology Foundation