DEEP VENOUS THROMBOSIS IN PATIENTS WITH TRANSVENOUS FEMORAL TEMPORARY PACEMAKERS
O. Farouque*, P. Sanders, G.D. Young, L.J. Mahar.
Department of Cardiology, Royal Adelaide Hospital, Adelaide, South Australia.
Introduction: The aim of this study was to prospectively determine the incidence of deep venous thrombosis (DVT) in patients (P) with transvenous femoral temporary pacemakers (TFTP) and to evaluate the effects of differing anticoagulant (AC) regimes.
Methods: Consecutive P having TFTP were enrolled in the study. A femoral venous sheath was used in all cases. All P had daily examinations and a duplex ultrasound scan (USS) of the venous system of both lower limbs within 24 hours of removal of the TFTP. The anticoagulation (AC) regime used was at the discretion of the treating cardiologist, consisting either of low dose unfractionated heparin (5000 units subcutaneously twice daily) or high dose heparin aiming for therapeutic AC.
Results: 21 P met entry criteria and had USS performed; 14 male, mean age of 72 years (46-84). 8 of 21 P (38%) had USS evidence of DVT of which only 1 (12.5%) was clinically apparent. 7 of 8 (87.5) DVT was located in the thigh veins and 1 (12.5) in the calf veins. There was no thrombus in the limb not used for pacing and no P developed clinical evidence of pulmonary embolism. 9 (43%) P received low dose AC and 12 (57%) high dose AC. 6 of 9 (66.7%) receiving low dose AC had DVT, compared to 2 of 12 (16.7%) receiving high dose AC (p=0.03). 1 of 11 (9%) P who were < 75 years had DVT compared to 7 of 10 (70%) who were > 75 years (p=0.008). No significant association was found between the incidence of DVT and sex, haemodynamic status, sheath size or the length of time the TFTP was insitu.
Conclusion: the incidence of DVT is high in patients with TFTP, particularly in the elderly and those receiving low dose AC. If a TFTP is used, we recommend high dose AC should be employed to minimise the risk of DVT and USS should be performed to look for DVT.
