Clinically Significant Pocket Hematoma Increases Long-Term Risk of Device Infection Academic Article uri icon

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abstract

  • BACKGROUND: The BRUISE CONTROL trial (Bridge or Continue Coumadin for Device Surgery Randomized Controlled Trial) demonstrated that a strategy of continued warfarin during cardiac implantable electronic device surgery was safe and reduced the incidence of clinically significant pocket hematoma (CSH). CSH was defined as a post-procedure hematoma requiring further surgery and/or resulting in prolongation of hospitalization of at least 24 h, and/or requiring interruption of anticoagulation. Previous studies have inconsistently associated hematoma with the subsequent development of device infection; reasons include the retrospective nature of many studies, lack of endpoint adjudication, and differing subjective definitions of hematoma. OBJECTIVES: The BRUISE CONTROL INFECTION (Bridge or Continue Coumadin for Device Surgery Randomized Controlled Trial Extended Follow-Up for Infection) prospectively examined the association between CSH and subsequent device infection. METHODS: The study included 659 patients with a primary outcome of device-related infection requiring hospitalization, defined as 1 or more of the following: pocket infection; endocarditis; and bloodstream infection. Outcomes were verified by a blinded adjudication committee. Multivariable analysis was performed to identify predictors of infection. RESULTS: The overall 1-year device-related infection rate was 2.4% (16 of 659). Infection occurred in 11% of patients (7 of 66) with previous CSH and in 1.5% (9 of 593) without CSH. CSH was the only independent predictor and was associated with a >7-fold increased risk of infection (hazard ratio: 7.7; 95% confidence interval: 2.9 to 20.5; p < 0.0001). Empiric antibiotics upon development of hematoma did not reduce long-term infection risk. CONCLUSIONS: CSH is associated with a significantly increased risk of infection requiring hospitalization within 1 year following cardiac implantable electronic device surgery. Strategies aimed at reducing hematomas may decrease the long-term risk of infection. (Bridge or Continue Coumadin for Device Surgery Randomized Controlled Trial [BRUISE CONTROL]; NCT00800137).

authors

  • Essebag, Vidal
  • Verma, Atul
  • Healey, Jeffrey Sean
  • Krahn, Andrew D
  • Kalfon, Eli
  • Coutu, Benoit
  • Ayala-Paredes, Felix
  • Tang, Anthony S
  • Sapp, John
  • Sturmer, Marcio
  • Keren, Arieh
  • Wells, George A
  • Birnie, David H
  • Green, Martin
  • Nery, Pablo
  • Lemery, Robert
  • Gollob, Michael
  • Davis, Darryl
  • Redpath, Calum
  • Duchesne, Lloyd
  • Carlin, Leslie
  • MacDonald, Karen
  • Dunne, Rosemary
  • Fleming, Rochelle
  • Yeltsir, Elizabeth
  • Chen, Li
  • Tran, My-Linh
  • Coyle, Doug
  • Hadjis, Tomy
  • Bernier, Martin L
  • Omelchenko, Alexander
  • Rafti, Fiorella
  • Beaudoin, Johannie
  • Bureau, Johanne
  • Coutu, Isabelle
  • Vaillancourt, Emilie
  • Manlucu, Jaimie
  • Yee, Raymond
  • Skanes, Allan
  • Gula, Lorne
  • Klein, George
  • Leong-Sit, Peter
  • Nyman, Lynn
  • Bentley, Cathy
  • Hulley, Denise
  • Morillo, Carlos
  • Connolly, Stuart
  • Nair, Girish
  • Divakaramenon, S
  • Ribas, S
  • Eikelboom, John
  • Meyer, Wendy
  • Malcolm, Victoria
  • Carroll, Sandra
  • Simpson, Christopher S
  • Baranchuk, Adrian
  • Abdollah, Hashiar
  • Michael, Kevin
  • Redfearn, Damian
  • Hammond, Sharlene
  • Ewart, Gwen
  • Fair, Sharon
  • O’Reilly, Glenda
  • Novak, Paul
  • Sterns, Laurence
  • Leather, Richard
  • Smith, Reg
  • Lane, Chris
  • Bastell, Mona
  • Parfett, Debbie
  • Green, Andrea
  • Jackson, Heather
  • Basta, Magdy
  • Gardner, Martin
  • Parkash, Ratika
  • Gray, Chris
  • Fearon, Ann
  • Giddens, Karen
  • Carroll, Lisa
  • Kus, Teresa
  • Hadjis, Tomy
  • Becker, Guiliano
  • Langlois, Ann
  • Sirois, Carole
  • Khaykin, Yaariv
  • Wulffhart, Zaev
  • Tsang, Bernice
  • Pantano, Alfredo
  • Winger, Kellie
  • Patterson, Sherri
  • Nath, Annette
  • Seifer, Colette
  • Wolfe, Kevin
  • Khadem, Ali
  • Tischenko, Alex
  • Polson, Jan
  • Roux, Jean-Francois
  • Badra, Mariano
  • Cote, Stephanie
  • Lavallee, Lyne
  • Houde, Rene
  • Crystal, Eugene
  • Lashevsky, Ilan
  • Lau, Ching
  • Laish-Farkash, Avishag
  • Costa Vitali, Atilio
  • Singh, Sheldon
  • Tiong, Irving
  • Ahmadzai, Fahema
  • Khurana, Mamta
  • Lakhanpal, Meena
  • Lukomsky, Maria
  • Shurrab, Mohammed
  • Costi, Paolo
  • Greiss, Isabelle
  • Mansour, Fadi
  • Raymond, Jean-Marc
  • Bergeron, Martine
  • Roby, Nancy
  • Ahmad, Kamran
  • Dorian, Paul
  • Mangat, Iqwal
  • Korley, Victoria
  • Pinter, Arnold
  • Aves, Theresa
  • Mariano, Zana
  • Estacio, Antonio
  • Rinne, Claus
  • Janzen, Irene
  • Lowery, Donna
  • Kenyon, Naomi
  • Jonson, Kaler
  • Toal, Satish
  • Stevenson, Robert
  • Searles, Gregory
  • Douglas, Geoffrey
  • Bessoudo, Ricardo
  • Hassan, Ansar
  • Collings, Elizabeth
  • Braam, Corinne
  • Fitzgerald, Fabia
  • Kent, Donna
  • Mychaluk, Luana
  • Kavanagh, Katherine
  • Exner, Derek
  • Burgess, John
  • Rothschild, John
  • Kuriachan, Vikas
  • Sumner, Glen Linnell
  • Keller, Debbie
  • Yuen, Brian
  • Jackson-Carter, Leslie
  • Dorey, Sandra
  • Leiria, Tiago LL
  • Sant’Anna, Roberto Tofani
  • de March Ronsoni, Rafail
  • Pereira, MA Moraes
  • Moraes, Antonieta
  • Rodrigues, Juliane

publication date

  • March 2016

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