Incidence and possible determinants of device-pocket haematoma after cardiac implantable electronic devices in patients treated with a pressure dressing

Abstract Aims Device-pocket haematoma (DPH) occurs in 2–15% of the implantations of cardiac rhythm devices. Major bleedings occur in 0.2–2% of the cases. The present study aims to evaluate the incidence of DPH in patients treated with a pressure dressing after implantation of a pacemaker and to investigate the impact of antiplatelet and anticoagulant therapy on DPH in the same cohort. Methods and results A retrospective evaluation on 446 consecutive patients who underwent implantation or replacement of pacemaker/ICD between 2017 and 2018 was performed. Cardiovascular risk factors, clinical parameters, medical history of the patients, as well as their drug history were collected. The presence or absence of perioperative DPH was investigated. All patients were treated with a pressure dressing immediately after the procedure and for the first 24 h. The preliminary results obtained after reviewing the medical records of the 446 patients (age 76.8 ± 10.4 years; 67% males; left ventricular ejection fraction 47.3 ± 12.2%) show an incidence of DPH of 8.1% (n = 36). 332 (74%) of the patients had documented hypertension, 131 (29%) diabetes, 213 (48%) were taking antiplatelet medications, and 150 (34%) were taking anticoagulants. No significant differences were found directly comparing the main variables under study between patients who experienced DPH and those who did not. However, at binomial logistic regression analysis, performed including antithrombotic therapies, sex, and age, a tendency of patients treated with warfarin to experience DPH emerged (OR : 3.25, 95% CI : 1.00–10.50; P = 0.049). Conclusions The preliminary results of the present study show an incidence of DPH of 8.1% in patients treated with a pressure dressing after pacemaker implantation. Between antithrombotic therapies, sex and age, anticoagulation therapy with warfarin appeared to be correlated with an increased risk of DPH.