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Case Reports
. 2022 Feb 24:9:817453.
doi: 10.3389/fcvm.2022.817453. eCollection 2022.

Effect of a Novel Pocket Compression Device on Hematomas Following Cardiac Electronic Device Implantation in Patients Receiving Direct Oral Anticoagulants

Ye-Ping Fei  1 , Lei Wang  2 , Chun-Yan Zhu  1 , Jing-Chao Sun  1 , Hui-Lin Hu  1 , Chang-Lin Zhai  1 , Chao-Jie He  1
Affiliations
Case Reports

Effect of a Novel Pocket Compression Device on Hematomas Following Cardiac Electronic Device Implantation in Patients Receiving Direct Oral Anticoagulants

Ye-Ping Fei et al. Front Cardiovasc Med. .

Abstract

Background: A pocket hematoma is a well-recognized complication that occurs after pacemaker or defibrillator implantation. It is associated with increased pocket infection and hospital stay. Patients suffering from atrial fibrillation and undergoing cardiovascular electronic implantable device (CIED) surgery are widely prescribed and treated with direct oral anticoagulants (DOACs). In this study, the use of a novel compression device was evaluated to examine its ability to decrease the incidence of pocket hematomas following device implantation with uninterrupted DOACs.

Methods: A total of 204 participants who received DOACs and underwent CIED implantation were randomized into an experimental group (novel compression device) and a control group (elastic adhesive tape with a sandbag). The primary outcome was pocket hematoma, and the secondary outcomes were skin erosions and patient comfort score. Grade 3 hematoma was defined as a hematoma that required anticoagulation therapy interruption, re-operation, or prolonged hospital stay.

Results: The baseline characteristics of both groups had no significant differences. The incidence of grades 1 and 2 hematomas was significantly lower in the compression device group than in the conventional pressure dressing group (7.8 vs. 23.5 and 2.0 vs. 5.9%, respectively; P < 0.01). Grade 3 hematoma occurred in 2 of 102 patients in the experimental group and 7 of 102 patients in the control group (2.0 vs. 6.9%; P = 0.03). The incidence rates of skin erosion were significantly lower, and the patient comfort score was much higher in the compression device group than in the control group (P < 0.01). Multivariable logistic regression analysis showed that the use of novel compression device was a significant protective factor for pocket hematoma (OR = 0.42; 95% CI, 0.29-0.69, P = 0.01).

Conclusions: The incidence of pocket hematomas and skin erosions significantly decreases when the proposed compression device is used for patients undergoing device implantation with uninterrupted DOACs. Thus, the length of hospital stay and re-operation rate can be reduced, and patient comfort can be improved.

Clinical trial registration: http://www.chictr.org.cn, identifier: ChiCTR2100049430.

Keywords: cardiovascular electronic implantable device; direct oral anticoagulants; pocket compression device; pocket hematoma; skin erosion.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Conventional pressure dressing with adhesive tape.
Figure 2
Figure 2
Novel pocket compression device.
Figure 3
Figure 3
Structural diagram of the new compression device. 1, Shoulder strap fixing hole; 2, pressure-adjusting knob; 3, pressure-adjusting screw; 4, support plate; 5, shoulder band; 6, chest band; and 7, breather hole.
Figure 4
Figure 4
Flowchart of the study.
See this image and copyright information in PMC

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