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Arguments to Apply Epinephryne for Pocket Hematoma Reduction. The MAITRE study

Pocket hematoma (PH) is a common complication of implantations of cardiac electro-physiological devices with especially high rate in patients on oral anticoagulation or antiplate-let treatment. Different pharmacological agents with hemostatic effect are used to avoid PH. We supposed that vasoconstrictor effects of epinephrine may reduce bleeding extent and be effective in prevention of PH. Maitre is a first clinical trial conducted with an aim to show safety and efficacy of epinephrine in PH prophylaxis. 133 patients were included in this trial, receiving after randomization either epinephrine or saline solution added to a local anesthetic during pacemaker implantation. In cases of diffuse bleeding a method of pocket draining was effectively used. Results showed that a risk of PH was statistically higher in group of epineph-rine. We consider that a local epinephrine effect may lead to a false impression of an adequate hemostasis and force a surgeon to refuse from drainage insertion.

Credits: Nikolay Ilov; Anatoly Nechepurenko; Albert Abdulkadyrov; Damir Paskeev; Elena Damrina; Elena Kulikova; Marina Terent’eva; Dinara Stompel; Dmitry Tarasov

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