Observational Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Apr 26, 2023; 15(4): 174-183
Published online Apr 26, 2023. doi: 10.4330/wjc.v15.i4.174
Perioperative coagulation activation after permanent pacemaker placement
Roman Kalinin, Igor Suchkov, Vladislav Povarov, Nina Mzhavanadze, Olga Zhurina
Roman Kalinin, Igor Suchkov, Vladislav Povarov, Nina Mzhavanadze, Department of Cardiovascular, Endovascular Surgery and Diagnostic Radiology, Ryazan State Medical University, Ryazan 390026, Russia
Vladislav Povarov, Department of Surgical Treatment of Cardiac Arrhythmias and Cardiac Pacing, Ryazan State "Regional Clinical Cardiology Dispensary", Ryazan 390026, Russia
Olga Zhurina, Scientific and Clinical Center for Hematology, Oncology and Immunology, Ryazan State Medical University, Ryazan 390026, Russia
Author contributions: Kalinin R and Suchkov I were the guarantors and designed the study; Povarov V, Mzhavanadze N and Zhurina O participated in the acquisition, analysis, and interpretation of the data, and drafted the initial manuscript.
Institutional review board statement: This study was approved by the Local Ethics Committee of the Ryazan State Medical University.
Informed consent statement: All patients signed an informed consent.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Nina Mzhavanadze, MD, PhD, Professor, Department of Cardiovascular, Endovascular Surgery and Diagnostic Radiology, Ryazan State Medical University, Vysokovoltnaya 9, Ryazan 390026, Russia. nina_mzhavanadze@mail.ru
Received: December 27, 2022
Peer-review started: December 27, 2022
First decision: February 20, 2023
Revised: March 5, 2023
Accepted: April 12, 2023
Article in press: April 12, 2023
Published online: April 26, 2023
Processing time: 113 Days and 23.2 Hours
ARTICLE HIGHLIGHTS
Research background

Bradyarrhythmias are typically treated with permanent pacemakers (PM). The elimination of bradyarrhythmia by PM implantation improves the patient's quality of life and prognosis, but it can also result in a number of sequalae.

Research motivation

It is still unclear how PM implantation affects the hemostasis system's parameters and how such parameters relate to different complications after PM placement.

Research objectives

To assess the blood coagulation factor activity in PM patients throughout the perioperative period.

Research methods

Patients treated in the Department of Surgical Therapy of Cardiac Arrhythmias and Pacing at the Ryazan State "Regional Clinical Cardiology Dispensary" from April 2020 to December 2021 were included in the study. Before surgery, 7 and 30 d after PM placement, peripheral venous blood samples were withdrawn to measure the level of blood coagulation factor I (FI) and the activity of blood coagulation factors II (FII), V (FV), VII (FVII), VIII (FVIII), IX (FIX), X (FX), XI (FXI), XII (FXII). We used an automatic coagulometer Sysmex CA 660 (Sysmex Europe, Germany) and reagents from Siemens (Siemens Healthcare Diagnostics Products GmbH, Germany).

Research results

The study included 146 patients. The activity of factors FV [147.7 (102.1-247.55)% vs 103.85 (60-161.6)% vs 81.8 (67.15-130.65)%, P = 0.002], FVIII [80.4 (60.15-106.25)% vs 70.3 (48.5-89.1)% vs 63.7 (41.6-88.25)%, P = 0.039], FIX [86.2 (70.75-102.95)% vs 75.4 (59.2-88.3)% vs 73.9 (56.45-93.05)%, P = 0.014], FX [188.9 (99.3-308.18)% vs 158.9 (83.3-230)% vs 127.2 (95.25-209.35)%, P = 0.022], FXI [82.6 (63.9-103.6)% vs 69.75 (53.8-97.6)% vs 67.3 (54.25-98.05)%, P = 0.002], FXII [87.6 (67.15-102.3)% vs 78.9 (63.4-97.05)% vs 81.2 (62.15-97.4)%, P < 0.001] decreased at 7 and 30 d after surgery; FII activity [157.9 (109.7-245.25)% vs 130 (86.8-192.5)% vs 144.8 (103.31-185.6)%, P = 0.021] decreased at 7 d and increased at 30 d postoperatively. There were no statistically significant changes in the FVII activity within 30 d after PM placement [182.2 (85.1-344.8)% vs 157.2 (99.1-259)% vs 108.9 (74.9-219.8)%, P = 0.128]. Subgroup analysis revealed similar changes only in patients on anticoagulant therapy. FXII activity decreased in patients on antiplatelet therapy [82 (65.8-101.9)% vs 79.9 (63.3-97.1)% vs 89.7 (75.7-102.5)%, P = 0.01] 7 d after surgery, returning to baseline values at 30 d postoperatively.

Research conclusions

PM placement and anticoagulant therapy were associated with decreased activity of clotting factors FV, FVIII, FIX, FX, FXI, FXII in the postoperative period. FVII activity did not decrease within 30 d after PM placement, which may indicate endothelial injury caused by lead placement.

Research perspectives

We think that further investigation of hemostasis system will contribute to the creation of newer approaches to the detection, prognosis, management, and prevention of numerous hemorrhagic and thromboembolic complications in patients requiring PM implantation.