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Risk Factors and Preventing Strategies of Pocket Hematoma After Cardiac Implantable Electronic Device Implantation: A

Siyin Ding1,2,3, Xiaohong Pan1,2,3

  • 1Department of Cardiology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China.

Journal of Cardiovascular Development and Disease
|December 24, 2025
PubMed

Insights

Clinically significant pocket hematoma after cardiac device implantation is linked to higher infection and mortality. Optimizing antithrombotic management and using new preventive tools are crucial for high-risk patients.

Area of Science:

  • Cardiology
  • Medical Device Complications

Background:

  • Pocket hematoma is a frequent complication of cardiac implantable electronic device (CIED) implantation.
  • Traditionally viewed as a localized issue, significant pocket hematoma (CSH) is now recognized to increase infection rates, healthcare costs, and mortality.

Purpose of the Study:

  • To review current evidence on the pathogenesis, adverse outcomes, and prevention of CIED pocket hematoma.
  • To highlight the underappreciated clinical significance of CSH and the need for improved periprocedural management.

Main Methods:

  • This review synthesizes existing literature on pocket hematoma following CIED implantation.
  • Evidence regarding risk factors, clinical outcomes, and preventive strategies was analyzed.

Main Results:

  • Key risk factors for CSH include advanced age, low BMI, chronic kidney disease, complex procedures, and specific antithrombotic strategies (uninterrupted DAPT, heparin bridging).
  • Certain anticoagulation protocols (VKA, DOACs) may present lower bleeding risks than others.
  • Novel compression devices and hemostatic agents show potential for prevention.

Conclusions:

  • CSH is a significant complication with multifactorial causes and serious adverse outcomes.
  • Standardized definitions and risk stratification are needed.
  • Optimized periprocedural management, particularly antithrombotic strategies, is critical for high-risk patients undergoing CIED procedures.

Keywords:
antithrombotic therapycardiac implantable electronic devicescomplication preventionperioperative managementpocket hematoma

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