• Samir M Said, Hans D Esperer, Judit Hahn, Andreas Bollmann, Sergio Richter, Thomas Rauwolf, Roland Prondzinsky, Alexander Schmeisser, and Ruediger C Braun-Dullaeus.
• Division of Cardiology, Centre of Internal Medicine, University Hospital Magdeburg, Otto-von-Guericke University, Leipziger Str. 44, 39120 Magdeburg, Germany. samir.said@med.ovgu.de
• Clin Res Cardiol. 2013 May 1; 102 (5): 345-9.

ObjectiveWe retrospectively assessed the incidence of hemorrhagic complications associated with pacemaker implantation in patients receiving one or more antiplatelet agents.Design And SettingRetrospective multicenter case-control study. Data were collected from three cardiac units in Germany from 2006 to 2010.MethodsA total of 495 pacemaker patients were enrolled. 99 patients received dual antiplatelet therapy (aspirin and clopidogrel), 198 were given only aspirin and 198 had no antiplatelet therapy (control). Patients were matched for age and sex. Implant-related bleeding complications were defined as major bleeding, if surgical pocket exploration or blood transfusion were needed. Minor bleeding complications were defined as one or more of the following conditions: fall of hemoglobin content >1.5 g/dl not requiring blood transfusion; pocket hematoma; pocket effusion not requiring surgical revision.Measurements And ResultsHemorrhagic complications were seen in 4/198 control patients and 6/198 aspirin-only patients [2 vs. 3 %, p = 0.5, OR = 1.52 (0.42-5.46)]. Patients undergoing dual antiplatelet therapy had significantly more bleeding complications than patients in the aspirin-only group [11/99: 11.1 vs. 3 %, p = 0.005, OR = 3.95 (1.43-11.16)]. Major complications occurred in 1/198 control patients and 2/198 aspirin-only patients [0.5 vs. 1 %, p = 0.6, OR = 2.01 (0.18-22.35)]. In contrast, 7/99 patients undergoing dual antiplatelet therapy exhibited major complications [7.1 vs. 1 %, p = 0.004, OR = 7.46 (1.52-36.50)].ConclusionsAlthough in patients undergoing pacemaker implantation dual antiplatelet therapy with aspirin and clopidogrel caused a significant increase of bleeding complications, the use of aspirin alone was not associated with a significant increase in bleeding complications.

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