Key result
In patients with permanent pacemakers, upper extremity venous obstruction was found in 17% and was significantly associated with higher D-dimer levels (P<0.001) and FVII activity (P=0.025).
Why the study?
Intravascular leads create prerequisites for venous thromboembolism and venous obstruction, but hemostatic parameters as potential diagnostic factors remained to be evaluated.
Do hemostatic system parameters predict upper extremities veins obstruction in patients with permanent pacemakers?
Cross-Sectional (n=53)
Do hemostatic system parameters predict upper extremities veins obstruction in patients with permanent pacemakers?
High FVII activity, AT III, and D-dimer levels are associated with upper extremity venous obstruction in patients with permanent pacemakers, potentially serving as diagnostic markers before new lead placement.
May identify hemostatic markers for upper-extremity venous obstruction post-PM; hypothesis-generating and requires prospective validation before clinical use.
BACKGROUND: Cardiac implantable electronic devices (CIED) are widely used in the treatment of brady- and tachyarrhythmias, as well as chronic heart failure. The presence of a lead in the venous system creates the prerequisites for the venous thromboembolism and venous obstruction. The aim of our study was to evaluate the parameters of the hemostatic system in patients with permanent pacemaker (PM) as potential diagnostic factors for upper extremities veins obstruction.METHODS: Before PM placement, all patients underwent peripheral venous blood sampling. After sampling, the blood was centrifuged, the resulting plasma was used to determine the parameters of the patients’ hemostatic system: levels of fibrinogen, soluble P-selectin, soluble fibrin-monomer complex, D-dimer, plasminogen activator inhibitor type 1, activity of blood coagulation factors II, V (FV), VII (FVII), VIII, IX (FIX), X, XI, XII, von Willebrand factor, plasminogen, antithrombin III (AT III), protein C. Additionally, general blood test indicators were determined: platelet level, platelet volume distribution, average platelet volume. Ultrasound examination was performed to assess the patency of the veins of the upper and lower extremities. Echocardiography was performed to assess the structure and function of the heart.RESULTS: The study included 53 patients, in 9 (17%) of them, duplex ultrasound of the upper extremities veins revealed signs of the venous obstruction. The differences in the studied parameters were assessed in patients with identified venous obstruction and with normal venous patency. As compared to those with patent veins, patients with identified stenosis/occlusion of the veins of the upper extremities were characterized by higher activity of FV (77.2 (48.3-100.85)% and 93.9 (83.5-169.09)%, P=0.02), FVII (86.55 (53.35-126.9)% and 126.2 (88.6-199)%, P=0.025), FIX (82 (69.8-110.6)% and 110 (89.7-177.8)%, P=0.007) and higher level of D-dimer (500 (300-800) µg/l and 2000 (1000-2000) µg/l, P<0.001), respectively. High FVII activity, AT III and high D-dimer levels were associated with the venous obstruction.CONCLUSIONS: Upper extremities venous obstruction is a significant clinical problem in cases where there is a need to place a new lead. In our study, high FVII activity, AT III and high D-dimer levels were associated with the presence of stenosis/occlusion of the upper extremity veins in patients with PM.
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Povarov et al. (2024) conducted a cross-sectional in Permanent pacemakers (n=53). Elevated hemostatic parameters (FVII, AT III, D-dimer) vs. Normal hemostatic parameters was evaluated on Upper extremities veins obstruction. In patients with permanent pacemakers, upper extremity venous obstruction was found in 17% and was significantly associated with higher D-dimer levels (P<0.001) and FVII activity (P=0.025).
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