Abstract 5699: Antiplatelet Effect on Pocket Hematoma Rate in ICD Implantation
Introduction: Ischemic cardiomyopathy accounts for the majority of pt undergoing ICD implantation. This presents challenges with respect to antiplatelet therapy and bleeding risk during implant. The risk of pocket hematoma as it relates to antiplatelet therapy alone and in combination with anticoagulation therapy during ICD implantation has not been well studied. We hypothesize that dual antiplatelet therapy and in conjunction with elevated INR due to warfarin therapy increases the risk of pocket hematoma related to ICD implantation.
Methods: A retrospective analysis of 901 consecutive patients undergoing ICD implantation at the University of Alabama at Birmingham between 5/04 and 6/07 was performed. The medical record was reviewed for the presence of pocket hematoma. Statistical analysis including logistic regression was used to identify independently associated variables and pocket hematoma formation.
Results: 31 pocket hematomas were observed, of which 14 patients were taking clopidogril (8% hematoma rate) vs. 17 (2.4% hematoma rate) in those implanted without use of clopidogril (OR=3.6, CI=1.7–7.4, p=0.001). Logistic regression found the adjusted OR for the use of ASA alone, clopidogrel alone and combination therapy (vs. no antiplatelet therapy) was 0.81(CI=0.3–2.2, p=0.688), 1.91 (CI=0.21–17.1, p=0.56) and 4.3 (CI=1.6 –11.5, p=0.003), respectively. Additionally, for every 1.0 unit increase in INR there was a 2.13 OR (CI= 1.11– 4.09) of pocket bleed with or without antiplatelet therapy. Length of hospital stay was longer in the pocket hematoma group vs. non hematoma group (1.5+/− 2.39+/− 4.8 days, p=0.05).
Conclusions: The intensity of anticoagulation therapy including dual antiplatelet therapy impacts the complication rate for ICD implantation. Interruption of clopidogrel when safe, should be considered prior to ICD implantation.