Cardiac implantable electronic device hematomas: Risk factors and effect of prophylactic pressure bandaging

Background: Cardiac implantable electronic device (CIED) hematomas are associated with many adverse outcomes. We examined the incidence and risk factors associated with hematoma formation post-CIED implantation, and explored the preventative effect of prophylactic pressure bandaging (PPB) in a large tertiary center. Methods: 1,091 devices were implanted during October 2011–December 2014. Clinically significant hematomas (CSH) were those that necessitated prolonged admission, including those due to reoperation, and clinically suspicious hematomas were swellings noted by medical/nursing staff. We screened for variables affecting hematoma incidence prior to conducting multivariate logistic regression analyses, one for all hematomas and one for CSH. Results: 61 hematomas were identified (5.6% of patients), with 12 of those clinically significant (1.1% of patients). Factors significantly increasing the odds of developing any hematoma were stage 2 (odds ratio [OR] = 2.93, 95% confidence interval [CI] [1.08–7.94], P = 0.034) and 3 chronic kidney disease (CKD) (OR = 3.39 [1.20–9.56], P = 0.021), unfractionated heparin/therapeutic enoxaparin (OR = 3.15 [1.22–8.14], P = 0.018), and dual antiplatelets–aspirin + clopidogrel (OR = 2.95 [1.14–7.65], P = 0.026) + other combinations. Body Mass index (BMI) 25.0–29.9 (OR 0.52 [0.28–0.98], P = 0.044) and >30 were associated with decreased hematoma risk (OR 0.43 [0.20-0.91], P = 0.028). Factors significant for CSH formation were unfractionated heparin/therapeutic enoxaparin (OR = 9.55 [1.83–49.84], P = 0.007) and aspirin + clopidogrel (OR = 7.19 [1.01–50.91], P = 0.048). PPB nonsignificantly increased the odds of total hematoma development (OR = 1.53 [0.87–2.69], P = 0.135), and reduced CSH (OR = 0.67 [0.18–2.47], P = 0.547). Conclusions: Heparin and dual antiplatelet use remain strong predictors of overall hematoma formation. CKD is a comparatively moderate predictor. BMI > 25 may decrease the risk of hematoma formation. PPB had nonsignificant effects on hematoma development.