A randomized trial comparing heparin initiation 6 h or 24 h after pacemaker or defibrillator implantation

Gregory F. Michaud*, Frank Pelosi, Matthew D. Noble, Bradley P. Knight, Fred Morady, S. Adam Strickberger

*Corresponding author for this work

Research output: Contribution to journalArticle

116 Scopus citations

Abstract

Objectives. The purpose of this randomized study was to evaluate the prevalence of pocket hematomas in patients treated with heparin 6 h or 24 h after pacemaker or defibrillator implantation. Background. The risks of pocket hematoma and need for evacuation after device implantation have not been defined in patients who require anticoagulation. Methods. Forty-nine consecutive patients with an indication for anticoagulation with heparin after implantable defibrillator or pacemaker implantation were randomized to receive intravenous heparin either 6 h (n = 26) or 24 h (n = 23) postoperatively. Both groups also received warfarin on a daily basis starting the evening of surgery. Twenty-eight patients who received postoperative warfarin alone and 115 patients who did not receive anticoagulation were followed up in a study registry. Results. A pocket hematoma developed in 6 of 26 patients (22%) who were treated with intravenous heparin 6 h postoperatively, as compared with 4 of 23 patients (17%) who were treated with intravenous heparin 24 h postoperatively (p = 0.7). In total, a pocket hematoma developed in 10 of 49 patients (20%) treated with heparin, 1 of 28 patients (4%) treated with warfarin alone and 2 of 115 (2%) patients who received no anticoagulation (p < 0.001). Conclusions. Intravenous heparin initiation 6 h or 24 h after pacemaker or defibrillator implantation is associated with a 20% prevalence of pocket hematoma formation. Warfarin therapy or no anticoagulation is associated with only a 2% to 4% risk of pocket hematoma formation. (C) 2000 by the American College of Cardiology.

Original languageEnglish (US)
Pages (from-to)1915-1918
Number of pages4
JournalJournal of the American College of Cardiology
Volume35
Issue number7
DOIs
StatePublished - Jun 1 2000

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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