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Long-term thrombosis after transvenous permanent pacemaker implantation
1Department of Cardiovascular Surgery, Akita University, Akita Medical Center, Japan.
Insights
Venous thrombosis occurs in 23% of patients after long-term transvenous pacemaker implantation. This study could not determine if anticoagulant drugs prevent this complication, necessitating further research.
Area of Science:
- Cardiology
- Vascular Surgery
Background:
- Long-term transvenous permanent pacemaker implantation can lead to venous thrombosis.
- The efficacy of prophylactic anticoagulant and antiaggregant drugs in preventing this complication is not well-established.
Purpose of the Study:
- To assess the incidence of venous thrombosis after long-term transvenous permanent pacemaker implantation.
- To evaluate the potential efficacy of prophylactic anticoagulant and antiaggregant drugs in preventing venous thrombosis.
Main Methods:
- Venograms were performed in 100 patients undergoing elective pacemaker replacement after a mean follow-up of 6.0 years.
- Patient data regarding lead characteristics and medication use were analyzed retrospectively.
Main Results:
- Venous abnormalities, including stenosis and total obstruction, were found in 23% of patients.
- No significant difference in venous abnormalities was observed based on the route of entry, lead insulation, number of leads, or use of anticoagulant/antiaggregant drugs.
- All patients with venous abnormalities remained asymptomatic, with 21 exhibiting collateral circulation.
Conclusions:
- The incidence of venous thrombosis after long-term transvenous pacing is 23%, potentially caused by endothelial trauma and venous stenosis.
- This retrospective study could not establish the efficacy of prophylactic anticoagulant and antiaggregant drugs.
- Further prospective studies are required to determine the effectiveness of these prophylactic measures.
Abstract:
To assess the efficacy of prophylactic administration of anticoagulant and antiaggregant drugs to prevent venous thrombosis after long-term transvenous permanent pacemaker implantation, venograms were performed in 100 consecutive patients at the elective replacement of the pacemaker. Mean follow-up period after initial transvenous permanent pacemaker implantation was 6.0 years. The venograms demonstrated normal in 77 patients. The remaining 23 venograms showed venous stenosis in 11 patients and total obstruction in 12 patients. Twenty-one of these 23 patients had venous collateral circulation. No difference was found in the incidence of venous abnormalities according to the route of entry, the lead insulation, the total number of the implanted leads, and anticoagulant and antiaggregant drugs. All these patients have remained asymptomatic. In conclusion, the incidence of venous thrombosis after long-term transvenous pacing is 23% and the causes of venous thrombosis may be endothelial trauma and underlying venous stenosis. As this article describes a retrospective limited study, we cannot find the efficacy of prophylactic administration of anticoagulant and antiaggregant drugs to prevent venous thrombosis formation after transvenous permanent pacemaker implantation. Further prospective study will be needed to assess the efficacy of prophylactic administration of anticoagulant and antiaggregant drugs.