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Pocket hematoma in patients with cardiac devices: prevalence, risk factors and outcome predictors
Session:
Painel 5- Arritmologia 4
Speaker:
André Grazina
Congress:
CPC 2020
Topic:
C. Arrhythmias and Device Therapy
Theme:
09. Device Therapy
Subtheme:
09.5 Device Complications and Lead Extraction
Session Type:
Posters
FP Number:
---
Authors:
André Grazina; Madalena Coutinho Cruz; Bruno Tereno Valente; Pedro Silva Cunha; Paulo Osório; Antonio; Inês Grácio De Almeida; Susana Covas; Manuel Braz; Rui Cruz Ferreira; Mário Martins Oliveira
Abstract
<p><strong>Introduction:</strong> The number of cardiac implantable electronic devices (CIED) procedures has increased over the past years. Pocket hematoma has been reported as a typically complication, with frequent need for reintervention and a potential impact in outcomes.</p> <p><strong>Objectives:</strong> To assess the prevalence and risk factors of pocket hematoma requiring surgical revision in a tertiary center, and to stablish potential adverse outcome predictors.</p> <p><strong>Methods:</strong> Between 2013 and 2018, there were 3489 new CIED implants, 986 generator replacements and 508 reinterventions in our center. Thirty-nine patients (P) underwent surgical revision to drain pocket hematomas (one of them twice). Among these, data baseline, type of CIED, anti-thrombotic therapy and clinical events (mortality and hospitalizations for cardiac causes) during follow-up were noted.</p> <p><strong>Results:</strong> 39P (76,1±11,8 years, 79,5% male, INR 1,64±0,80 and platelet count 181.000±67.000) developed pocket hematoma requiring surgical revision; a rate of 0,9% of total procedures. 56,4% (n=22) had pacemakers, 28,2% (n=11) cardiac resynchronization therapy devices and 15,4% (n=6) implantable cardioverter-defibrillators, with 56,4% (n=22) being previously submitted to one or more CIED procedures. All P were under anti-thrombotic therapy, with 59% (n=23) taking vitamin K antagonists (VKA) and 56,4% (n=22) having made bridging with enoxaparin. Thirty-four P were followed for a mean period of 19 months (5 lost to follow-up). Death occurred in 32,4% (n=11), with 20,6% (n=7) due to cardiac causes, mainly heart failure, 6,0% (n=4) due to renal failure, one hemorrhagic stroke and one septic shock (2,9% each), none related with the hematoma. Hospitalizations occurred in 50% (n=17), with cardiac cause in 32,4% and relation to the hematoma in only 5,9% (1P developed a new pocket hematoma and 1P had a pocket infection). Bridging with enoxaparin and renal function impairment (present in 53,8% of the cases) were predictors of re-hospitalization for cardiac reasons (OR 7,94 <em>p=</em>0,02, 95%CI 1,41-44,80 each), with VKA therapy and INR values showing statistical significance tendency (OR 5,50 <em>p=</em>0,05 95%CI 0,98-30,8 and OR 2,95 <em>p=</em>0,07 95%CI 0,92-9,44).</p> <p><strong>Conclusions:</strong> In our population, the rate of pocket hematoma needing reintervention was below 1%, with all P taking anti-thrombotic medication. Renal dysfunction and VKA therapy were predictors of re-hospitalization.</p>
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