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Europace Advance Access published online on March 16, 2006
Europace, doi:10.1093/europace/eul011
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© The European Society of Cardiology 2006. All rights reserved
Received January 23, 2004
Accepted January 3, 2006

Article

Post-operative use of heparin increases morbidity of pacemaker implantation

C. Marquie 1 *, G. De Geeter 1, D. Klug 1, C. Kouakam 1, F. Brigadeau 1, O. Jabourek 1, N. Trillot 1, D. Lacroix 1, and S. Kacet 1

1 CHRU, Cardiologie A, Cardiologic Hospital, bl du Pr, Lille 59037, France

* To whom correspondence should be addressed.
C. Marquie, E-mail: c-marquie{at}chru-lille.fr


  Abstract

Aims The objective of this study is to characterize the incidence of peri-operative severe adverse events (AEs) related to the post-operative use of heparin in patients undergoing pacemaker surgery.

Methods and results We retrospectively compared the outcome of 38 patients with mechanical valves (MVs) and 76 patients with atrial fibrillation (AF) with control cases matched for gender, age, and surgical details. Heparin was systematically used post-operatively in MV patients, but left to clinical judgment in AF patients. The relative risk for severe haemorrhagic AEs was 11 (CI 1.5-81.1, P < 0.01) in the MV group when compared with matched controls and 8 (CI 1.0-62.5, P < 0.05) in the AF group. Overall, the relative risk of heparin use in the post-operative period was 14 (CI 1.88-104, P = 0.0006) and the post-operative stay was prolonged from 7 days in this group when compared with control cases (P < 0.0001).The variables associated with haemorrhage were the delay to restart heparin after surgery and the presence of an MV.

Conclusion Post-operative use of heparin increases morbidity of pacemaker implantation. A different approach to management of these patients is possible.

Keywords: Pacemaker implantation; Heparin; Mechanical heart valves; Atrial fibrillation; Haemorrhage; Thrombo-embolism; Adverse events.
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