Clopidogrel Increases Bleeding Complications in Patients Undergoing Heart Rhythm Device Procedures

• Published in: Pacing and clinical electrophysiology Vol. 35; no. 5; pp. 605 - 611
• Main Authors: BOULÉ, STÉPHANE, MARQUIÉ, CHRISTELLE, VANESSON-BRICOUT, CLAIRE, KOUAKAM, CLAUDE, BRIGADEAU, FRANÇOIS, GUÉDON-MOREAU, LAURENCE, ACHERÉ, CHARLES, GOÉMINNE-BOULÉ, CÉLINE, LACROIX, DOMINIQUE, KLUG, DIDIER, KACET, SALEM
• Format: Journal Article
• Language: English
• Published: Malden, USA Blackwell Publishing Inc 01.05.2012; Wiley
• Subjects: Antiplatelet; Biological and medical sciences; Cardiac Resynchronization Therapy - statistics & numerical data; Case-Control Studies; Clopidogrel; Comorbidity; Complications; Diseases of the cardiovascular system; Drug-Related Side Effects and Adverse Reactions; Female; France - epidemiology; Hematoma; Hemorrhage - epidemiology; Humans; ICD; Male; Medical sciences; Middle Aged; Pacemaker; Platelet Aggregation Inhibitors; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Retrospective Studies; Risk Assessment; Risk Factors; Thrombosis - epidemiology; Thrombosis - prevention & control; Ticlopidine - analogs & derivatives; Ticlopidine - therapeutic use; Treatment Outcome; France; Heart; Human; Complications; Implantable cardioverter defibrillator; Instrumentation therapy; ICD; Hemorrhage; Antiplatelet agent; Instrumental stimulation; Antiplatelet; Pacemaker; Hematoma; Antithrombotic agent; Clopidogrel; Complication; Circulatory system; Thienopyridine derivative
• ISSN: 0147-8389; 1540-8159
• DOI: 10.1111/j.1540-8159.2012.03354.x

Background: Management of antiplatelet therapy at the time of device implantation remains controversial. This study aimed to assess the risk of bleeding complications in patients receiving clopidogrel at the time of cardiac device surgery. Methods: We performed a retrospective case‐control study. Between 2004 and 2010, 101 consecutive patients receiving clopidogrel underwent cardiac device surgery (pacemaker or implantable cardioverter–defibrillator implantation, and generator replacement) in our institution. Controls were 1:1 matched on age, sex, device, type of procedure, number of leads implanted, and venous approach (cephalic or subclavian). A significant bleeding complication was defined as pocket hematoma requiring surgical evacuation or prolonged hospitalization, hemothorax, pericardial effusion, or tamponade. Results: Bleeding complications occurred more frequently in patients receiving clopidogrel at the time of device procedure: 11.9% versus 4.0% (P = 0.037; odds radio [OR] 3.27 [1.02–10.5]). Significant bleeding complications were noted in 12 patients (11.9%) receiving clopidogrel, including two patients with pericardial effusion and one patient with hemothorax. Four controls (4.0%) had bleeding complications (three pocket hematomas and one pericardial effusion). The single factor associated with increased bleeding complications in patients receiving clopidogrel was subclavian puncture (P = 0.008). In the entire cohort (n = 202), multivariate analysis identified two independent predictors of significant bleeding complications: clopidogrel treatment at the time of surgery (P = 0.03; OR 3.7 [1.1–12.6]) and subclavian venous puncture (P = 0.03; OR 3.44 [1.1–10.4]). Conclusions: Clopidogrel treatment at the time of heart rhythm device procedures is associated with an increased risk of significant bleeding complications. Subclavian puncture seems to strongly increase hemorrhagic complications in this setting. (PACE 2012; 1–7)