Changes in Coagulation Parameters After Permanent Pacemaker Implantation

I.D. Yoncheva 1 , D.E. Biserov 1 , and M.N. Negreva 2
  • 1 University Hospital Virgin Mary, , Burgas, Bulgaria
  • 2 University Hospital St. Marina, , Varna, Bulgaria


The connection between venous thrombotic events in patients with implanted pacemakers and changes in coagulation factors has been the basis of numerous scientific studies for years. Results show that the effect on the coagulation system is a long-term and dynamic process, as well as presence of a significant dependence with many concomitant cardiovascular diseases.

Advances in medicine in recent decades and increase in life expectancy of patients with implanted cardiac devices (ICD) increase the risk of a variety of complications. These adverse events may be associated with development of thrombosis, change in the stimulation threshold, need for ablation due to concomitant rhythm pathology and others. Analysis of data from literature shows unequivocally that placement of endocardial electrodes leads to activation of the coagulation system in the body. On the one hand, this is a result of the direct traumatic moment and endothelial damage in the early post-procedure period, and subsequently, the presence of electrodes of the foreign body type in some individuals can provoke a procoagulation state.

More in-depth research is needed in this area to clarify the answers to these questions, namely: in which phase of the coagulation cascade are the changes most significant; is there a way to anticipate these changes and prevent them accordingly; is disturbed homeostasis of coagulation temporary or persistent.

These questions will be answered after sufficient data have been accumulated on these changes and how to modulate them.

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  • 1. Nayak R, Fernandes TM, Auger WR, Pretorius GV, Madani MM, Birgersdotter-Green UM. Contribution of Cardiac Implantable Electronic Devices to Thrombus Formation in Patients With Chronic Thromboembolic Pulmonary Hypertension. JACC Clin Electrophysiol. 2018;4(11):1431-36.

  • 2. Lelakowski J, Domagała TB, Rydlewska A, Januszek R, Kotula-Horowitz K, Majewski J, et al. Relationship between changes in selected thrombotic and inflammatory factors, echocardio-graphic parameters and the incidence of venous thrombosis after pacemaker implantation based on our own observations. Arch Med Sci. 2012;8(6):1027-34.

  • 3. Zabczyk M, Butenas S, Palka I, Nessler J, Undas A. Active tissue factor and activated factor XI in circulating blood of patients with systolic heart failure due to ischemic cardiomyopathy. Pol Arch Med Wewn. 2010;120(9):334-40.

  • 4. Spiezia L, Campello E, Valle FD, Woodhams B, Simioni P. Factor VIIa-antithrombin complex: a possible new biomarker for activated coagulation. Clin Chem Lab Med. 2017;55(4):484-88.

  • 5. Iskra T, Turaj W, Słowik A, Zwolińska G, Strojny J, Szczudlik A. Hemostatic markers of endothelial injury in ischaemic stroke caused by large or small vessel disease. Pol Merkur Lekarski. 2006;21(125):429-33. Polish.

  • 6. Zhang X, Li Y, Wang N, Zhang C, Zhang D, Li Q. Effects of permanent cardiac pacemaker implantation on vascular endothelial function, blood coagulation and cardiac function in patients with bradycardia. Exp Ther Med. 2018;16(6):4717-21.

  • 7. Madershahian N, Scherner M, Weber C, Kuhn E, Choi YH, Slottosch I, et al. Temporary biventricular pacing improves bypass graft flows in coronary artery bypass graft patients with permanent atrial fibrillation. Interact Cardiovasc Thorac Surg. 2015;21(4):435-40.

  • 8. Olson NC, Raffield LM, Lange LA, Lange EM, Longstreth WT Jr, Chauhan G, et al. Associations of activated coagulation factor VII and factor VIIa-antithrombin levels with genome-wide polymorphisms and cardiovascular disease risk. J Thromb Haemost. 2018;16(1):19-30.

  • 9. Yaegashi T, Furusho H, Kato T, Chikata A, Takashima S, Usui S, et al. Systemic excess of coagulation systems after implanting device leads for low voltage devices as well as high voltage devices. Europace. 2011;13 Suppl 3.

  • 10. Jaffer IH, Fredenburgh JC, Hirsh J, Weitz JI. Medical device-induced thrombosis: what causes it and how can we prevent it? J Thromb Haemost. 2015;13 Suppl 1:S72-81.

  • 11. Wilson CJ, Clegg RE, Leavesley DI, Pearcy MJ. Mediation of bio-material-cell interactions by adsorbed proteins: a review. Tissue Eng. 2005;11(1-2):1-18.

  • 12. Turbill P, Beugeling T, Poot AA. Proteins involved in the Vroman effect during exposure of human blood plasma to glass and polyethylene. Biomaterials. 1996;17(13):1279-87.

  • 13. Kazatchkine MD, Carreno MP. Activation of the complement system at the interface between blood and artificial surfaces. Biomaterials. 1988;9(1):30-5.

  • 14. Yau JW, Stafford AR, Liao P, Fredenburgh JC, Roberts R, Weitz JI. Mechanism of catheter thrombosis: comparison of the anti-thrombotic activities of fondaparinux, enoxaparin, and heparin in vitro and in vivo. Blood. 2011;118(25):6667-74.

  • 15. Steg PG, Jolly SS, Mehta SR, Afzal R, Xavier D, Rupprecht HJ, et al. Low-dose vs standard-dose unfractionated heparin for percutaneous coronary intervention in acute coronary syndromes treated with fondaparinux: the FUTURA/OASIS-8 randomized trial. JAMA. 2010;304(12):1339-49.

  • 16. Yau JW, Stafford AR, Liao P, Fredenburgh JC, Roberts R, Brash JL, et al. Corn trypsin inhibitor coating attenuates the prothrombotic properties of catheters in vitro and in vivo. Acta Biomater. 2012;8(11):4092-100.

  • 17. Larsson M, Rayzman V, Nolte MW, Nickel KF, Björkqvist J, Jämsä A, et al. A factor XIIa inhibitory antibody provides thromboprotection in extracorporeal circulation without increasing bleeding risk. Sci Transl Med. 2014;6(222):222ra17.

  • 18. Majeed A, Schulman S. Bleeding and antidotes in new oral anticoagulants. Best Pract Res Clin Haematol. 2013;26(2):191-202.

  • 19. Crosby JR, Marzec U, Revenko AS, Zhao C, Gao D, Matafonov A, et al. Antithrombotic effect of antisense factor XI oligonucleotide treatment in primates. Arterioscler Thromb Vasc Biol. 2013;33(7):1670-8.

  • 20. Salomon O, Steinberg DM, Zucker M, Varon D, Zivelin A, Seligsohn U. Patients with severe factor XI deficiency have a reduced incidence of deep-vein thrombosis. Thromb Haemost. 2011;105(2):269-73.

  • 21. Cuvillier E. Handbook of Leads for Pacing, Defibrillation and Cardiac Resynchronization. Santo Domingo: Editora Corripio; 2016. p. 67-90.


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