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Use of a pocket compression device for the prevention and treatment of pocket hematoma after pacemaker and defibrillator implantation (STOP-HEMATOMA-I)

Journal of Interventional Cardiac Electrophysiology volume 49, pages 197–204 (2017)Cite this article

Abstract

Background

Pocket hematoma is a recognized complication after placement of cardiac implantable electronic devices and is associated with increased device infection, length of hospitalization, and morbidity especially with uninterrupted antiplatelet agents and anticoagulants. We assessed the use of a post-surgical vest to decrease the incidence of pocket hematoma in patients undergoing device implantation with uninterrupted antiplatelet and anticoagulants.

Methods

In this observational study, a vest was used by 20 consecutive patients who were compared to 20 age-, gender-, procedure-matched patients who received standard care. All patients were continued on antiplatelet and anticoagulants in the perioperative period. The pocket was assessed at post procedure day 0, 2, and 7, respectively.

Results

There were no significant differences in the baseline characteristics between both groups. Baseline mean international normalized ratio (INR) was significantly higher in the vest group when compared with the control group (2.7 ± 0.4 vs. 2.2 ± 0.3 = <0.001). The incidence of pocket hematoma was significantly lower in the vest group than the control group (0 vs 30%, p = 0.02) at the end of 7 days. Control group had a total of six hematomas with one patient requiring evacuation and blood transfusion. The vest group had three hematomas on day 2 that resolved by day 7.

Conclusions

The risk of moderate or large pocket hematoma is significantly reduced with the use of this vest in high-risk patients undergoing implantable devices on uninterrupted antiplatelet and anticoagulants.

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Authors and Affiliations

  1. Division of Cardiovascular Medicine, University of Missouri Hospital and Clinics, Columbia, MO, USA

    Mohit K. Turagam

  2. Section of Electrophysiology, Sunshine Hospitals, Hyderabad, Telangana, India

    Darbhamulla V. Nagarajan

  3. Department of Cardiovascular Surgery, Jagiellonian University, John Paul II Hospital, Krakow, Poland

    Krzysztof Bartus

  4. Arizona Heart Rhythm Center, 500 W. Thomas Road, Suite 750, Phoenix, AZ, 85013, USA

    Akash Makkar & Vijay Swarup

Authors
  1. Mohit K. Turagam
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  2. Darbhamulla V. Nagarajan
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Correspondence to Vijay Swarup.

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Turagam, M.K., Nagarajan, D.V., Bartus, K. et al. Use of a pocket compression device for the prevention and treatment of pocket hematoma after pacemaker and defibrillator implantation (STOP-HEMATOMA-I). J Interv Card Electrophysiol 49, 197–204 (2017). https://doi.org/10.1007/s10840-017-0235-9

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  • DOI: https://doi.org/10.1007/s10840-017-0235-9

Keywords

  • Cardiac implantable electronic device
  • Pocket hematoma
  • Device complications
  • Hospital outcomes
  • Compression vest