Background: Pocket hematoma formation is a common complication after pacemaker and implantable cardioverter-defibrillator (ICD) placement. In this study, we investigated the influence of patients' comorbidities on the rate of pocket hematoma formation after pacemaker and ICD placement.
Methods: This study retrospectively evaluated a cohort of 458 patients(male 65%, mean age 71) who underwent pacemaker and ICD placement at Regions Hospital in St. Paul, MN from 01/2004 to 08/2008. Fifty seven percent patients were on warfarin, 27% on intravenous heparin or subcutaneous enoxaparin and 66% were on antiplatelet therapy at the time of device implantation. Predictors of pocket hematoma formation were analyzed by multivariate regression analysis. A P value of .0.05 was considered significant.
Results: The incidence of pocket hematoma was 2.2%. After adjusting for anticoagulation and antiplatelet agents, chronic kidney disease was found to be a significant risk factor of pocket hematoma formation after device implantation by multivariate regression analysis (Table). An increase of 1.0 mg/dl in creatinine levels was associated with two times higher rate of hematoma formation (OR 1.99, 95% CI 1.22-3.21, P=0.03).
Conclusions: Chronic kidney disease was found to be a significant risk factor of pocket hematoma formation after pacemaker and ICD placement
independent of anticoagulation and antiplatelet agents.

Predictors of pocket hematoma (multivariate regression analysis)
Predictor OR estimate, 95% CI P Value
Age 1.015 (0.96, 1.07) 0.61
Female Vs Male 2.20 (0.46, 10.5) 0.50
Obesity(BMI.30 kg/m2 ) 1.10 (0.98, 1.24) 0.09
Chronic Kidney Disease 4.37 (1.06, 18.1) 0.04
Diabetes Mellitus 0.57 (0.07, 4.98) 1.00
Hypertension 1.35 (0.17, 11.0) 1.00
Anemia(Hg<12 g/dl) 1.07(0.73, 1.57) 0.74
Smoking 1.15(0.30,4.37) 0.73