1例起搏器围术期抗凝治疗病例分析及文献复习

A case analysis and literature review of anticoagulation therapy during pacemaker surgery

目的:探讨长期服用华法林患者起搏器围术期抗凝治疗策略。方法:通过1例长期服用华法林患者起搏器围术期的抗凝治疗方案调整,结合最新国际相关临床使用指南和治疗进展,总结、分析围术期华法林抗凝治疗的选择。结果与结论:血栓栓塞风险高危者,可不停用华法林或以低分子肝素桥接,血栓栓塞风险低危或中危者,可以停用华法林,不以低分子肝素桥接。医生和药师需权衡患者出血和血栓风险决定起搏器围术期的抗凝方案。

Objective： To discuss anticoagulation therapy strategy during perioperative period of pacemaker implantation surgery in patients with long-term administration history of warfarin. Methods： Anticoagulation therapy strategy in perioperative period of pacemaker implantation surgery in patients with long-term administration history of warfarin was analyzed. According to the latest guidelines and treatment progress, the choice of warfarin in perioperative period was summarized and analyzed. Results and Conclusion： Patients with high thromboembolism risk can continue warfarin or bridge with low-molecular-weight heparin in perioperative period of pacemaker implantation surgery in patients with long-terra administration history of warfarin. Patients with low or middle thromboembolism risk should interrupt the use of warfarin without low-molecular-heparin bridging. Doctors and pharmacists should balance the risk of hemorrhage or thrombosis to decide the anticoagulation therapy in perioperative period of pacemaker.