The Golden Standard:

• Pocket hematoma formation is a common post compilation of implanting electronic cardiac devices such as pacemakers at the defibrillator site. This complication can lead to increase risk of infection, increased hospital stay and recovery time, and increased risk of morbidity (1)
  • These risks are increased when these patients receive constant antiplatelet agents and anticoagulants (2)
    • Solution: Better managing and lowering the amount of antiplatelet agents and anticoagulants the patient receives
    • Draw Back: The patient receiving the pacemaker or defibrillator implants need the antiplatelet and anticoagulant therapy (2)
  • A current device that significantly reduces the chances of hematoma formation is when the patient is on antiplatelet and anticoagulant therapy called Premofix®, a compression device (3)

Golden Standard – Compression of the site using compressive bandages, pressure tape, or compressive devices. If needed, exploratory surgery.

• Drawback of pressure tape is it can rip the skin of the patient leading to more risk of infection.  
• Drawback of surgery is increase risk of infection, mortality, and hospital stay.

Images:

Anticoagulants (“What Are Anticoagulants? Blood Thinner Drug Benefits & Side Effects.” DrugJustice, 12 Apr. 2019, http://www.drugjustice.com/news/xarelto/anticoagulants-blood-thinner-medication/. )

Citations:

• (1)Turagam, Mohit K et al. “Use of a pocket compression device for the prevention and treatment of pocket hematoma after pacemaker and defibrillator implantation (STOP-HEMATOMA-I).” Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacingvol. 49,2 (2017): 197-204. doi:10.1007/s10840-017-0235-9
• (2)Wiegand, Uwe K H et al. “Pocket hematoma after pacemaker or implantable cardioverter defibrillator surgery: influence of patient morbidity, operation strategy, and perioperative antiplatelet/anticoagulation therapy.” Chest vol. 126,4 (2004): 1177-86. doi:10.1378/chest.126.4.1177
• (3)Awada, Hassan et al. “Pocket related complications following cardiac electronic device implantation in patients receiving anticoagulation and/or dual antiplatelet therapy: prospective evaluation of different preventive strategies.” Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacingvol. 54,3 (2019): 247-255. doi:10.1007/s10840-018-0488-y