Abstract 2441: The Relationship Between Warfarin Continuation in the Peri-procedural Period and the Incidence of Hematoma Formation After Device Implantation
Background: Many patients (pt.) requiring permanent pacemaker (PPM) or implantable cardioverter defibrillator (ICD) placement are anticoagulated with warfarin for a number of indications. We sought to evaluate the relationship between warfarin continuation in the peri-procedural period and the incidence of hematoma formation after implantation.
Methods: We retrospectively reviewed consecutive pt. undergoing PPM and ICD implantation at our Hospital from January 2007 to January 2009. None of the patients on warfarin were requested to have it stopped before the implant. We collected data on the use of warfarin at implant, INR prior to implant, use of concomitant aspirin and/or clopidogrel with subsequent formation of hematoma in the peri-procedure period. The groups were compared using Fisher’s exact test for categorical variables and t-test for continuous ones. The data was expressed in mean±SD.
Results: PPM and ICD implantation were performed in 194 men and 6 women. The mean age was 73 years old. Fifty eight patients were taking warfarin with an INR of 1.94±0.62. Hematomas formed in a total of 8 patients, five of whom were on aspirin and clopidogrel (AP) (p value <0.0001) while only two of them were on warfarin (p value = 0.69). Pocket revision for hematoma evacuation was needed in 4 pt., three of whom were on AP and only one was on warfarin.
Conclusion: This study suggests that hematoma formation after PPM or ICD implantation is rare. In addition, hematoma formation in our group of pts. on warfarin was also uncommon, and very few pts with hematomas needed pocket revision for evacuation. This data also suggests that the use of AP may be associated with higher incidence of hematoma formation.