抗凝抗血小板药物围术期应用与起搏器植入术后囊袋血肿形成的关系研究

Relationship between Continuation of Anticoagulant or Antiplatelet Drugs during Peri-procedural Period and Incidence of Hematoma Formation after Device Implantation

目的研究围术期应用抗凝及抗血小板药物与起搏器植入术后囊袋血肿形成的关系。方法回顾2007年1月—2010年1月在我院植入或更换起搏器患者的临床资料,在不停用抗凝或抗血小板药物的情况下,对其中血栓高危患者术后囊袋血肿发生情况进行分析。结果共476例患者植入或更换起搏器,有14例出现围术期囊袋血肿并发症,发生率为2.9%,其中服用阿司匹林者6例,双联(阿司匹林联合氯吡格雷)抗血小板者5例,华法林者1例。进一步分析,双联抗血小板药物者血肿发生率较未服用抗凝抗血小板药物者、单用阿司匹林者为高(发生率分别为17.9%,0.7%和4.3%,P<0.05)。所有囊袋血肿经适当处理后好转出院。结论起搏器植入术后囊袋血肿的发生率较低,阿司匹林联合氯吡格雷明显增加起搏器术后囊袋血肿的发生,手术经验和恰当的术中操作有助于减少血肿的发生率。

Objective To investigate the relationship between anticoagulant or antiplatelet drugs continuation in the peri - procedural period and the incidence of hematoma formation after device implantation. Methods Retrospectively review the clinical information of the patients undergoing pacemaker implantation or replacement at our hospital from January 2007 to January 2010. Analyze the incidence of Hematoma formation after Device Implantation in the patients with high - risk of Thrombosis, under the condition of continuous use of anticoagulant or antiplatelet drugs in the peri - procedure period. Results Among the 476 patients implanted permanent pacemaker （PPM）, 14 patients had Capsular Hematomas during Peri -operation period, ac- counting for 2. 9% of the total patients, among which 6 took aspirin （ASA）, 1 was on warfarin and 5 were on dual -antiplatelet （DAPT） therapy. The Incidence of Hematoma Formation on dual - antiplatelet therapy increased Significantly （ P 〈 0. 05 ）. Pocket Hematoma was gradually absorbed by properly management. Conclusion This study suggests that hematoma formation af- ter PPM implantation is rare, even among those who are anticoagulated. Use of DAPT can imcrease the incidence of Hematoma formation. Surgical experience in the operation and proper technique can help reduce the incidence of hematoma.