Abstract 2439: Impact of Anticoagulation and Anti-platelet Therapy on ICD Implant-Related Bleeding and Thromboembolic Events in Patients Enrolled in the NCDR ICD Registry
Background: Dual anti-platelet (DAP) therapy is recommended for pts with drug-eluting stents. The impact of this and other anticoagulants (AC) on ICD implant-related bleeding and thromboembolic complication rates are unknown.
Methods: Pts enrolled in the NCDR ICD Registry from 1/06 to 6/08 were included. Pts with epicardial leads or missing discharge antiplatelet or AC details were excluded. Complications were defined as: “Hematoma” (resulting in reoperation or transfusion), “Non-Hematoma Bleeding” (including cardiac perforation, tamponade, or hemothorax) and “Thromboembolism” (peripheral embolus, TIA, stroke, MI or deep phlebitis).
Results: Among 263,412 ICD implants in 260,408 pts (mean age 68.0±12.9 yrs, 25.9% female), 2406 (0.91%) developed a hematoma, 483 (0.18%) had non-hematoma bleeding, and 322 (0.12%) had a thromboembolic event. Compared to pts on no antiplatelet or AC therapy, pts on DAP therapy (OR 1.47, 1.29 –1.68, P<0.001), warfarin alone (OR 1.20, 1.05–1.37, P=0.007), or triple therapy (DAP and warfarin) (OR 1.87, 1.53–2.29, P<0.001) more often experienced a post-implant hematoma. Class III and IV HF were independently associated with increased rates of hematoma, non-hematoma bleeding, and thromboembolism (see TABLE⇓).
Conclusions: Warfarin, DAP, and triple therapy are associated with increased hematoma and non-hematoma bleeding rates, although the overall rates are low. These findings should be considered when selecting pts for elective ICD implantation.