الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Pocket hematoma is a recognized common complication after placement of a permanent pacemaker (PM) or implantable cardioverter-defibrillator (ICD). Pocket hematomas are associated with local discomfort, an increased risk of infection, and may require surgical intervention or lead to lengthier hospital stays.
A variety of antiplatelet and anticoagulant drugs are routinely used in the treatment of cardiac patients. Antiplatelet therapy with aspirin (ASA) does not statistically increase the incidence of hematoma and is therefore thought to be an acceptable medication to continue perioperatively. Clopidogrel is a particularly potent antiplatelet drug. Its major mode of action is irreversible inhibition of ADP receptors, thus preventing platelet activation.
The use of high dose heparinization and combined ASA/thienopyridine treatment is highly predictive of the occurrence of intraoperative bleeding and pocket hematoma in patients who have undergone pacemaker and ICD implantation.
Local measures to decrease the incidence of pocket hematoma:
Surgeons usually use H2O2 (a topical antiseptic) at a concentration of 3%, which has been proven to oxidize proteins, nucleic acids, lipids of normal healthy cells, and microorganisms at the same time. Those actions explain its hemostatic and anti-bacterial actions.
Traditionally, electrocautery has been used to make surgical incisions on the skin, but recent data suggest that the diathermy blade allows the incision to be made more quickly, with less blood loss, less postoperative pain, and no adverse effects on wound healing or cosmetic effect.
The present work aimed to study the predictors of pocket hematoma formation post-pacemaker and defibrillator implantation and the role of the local measures in reducing its incidence.
This study included 100 consecutive patients who underwent implantation of a pacemaker or implantable cardioverter-defibrillator at Alexandria Main University Hospital (Electrophysiological Lab). 100 patients were divided into 2 groups: group one: 50 patients where local measures including bipolar diathermy and local hydrogen peroxide application were added. group two: 50 patients where local measures were not added.
The main results of the study revealed that:
● group I: 38 patients (76%) are hypertensive, 28 patients (56%) are diabetic, 24 patients (48%) are smokers, 3 patients (6%) are CKD, 22 patients (44%) have a Bleeding tendency,22 patients (44%) are haemoglobin less 10 p-value was (0.545), 34 patients (68%) intake (dual antiplatelet and anticoagulation),2 patients (4%) liver function,33patients (66%) are dyslipidemia. group II:41patients (82%) are hypertensive,2