长期抗凝者植入心脏植入装置围手术期抗凝策略

Perioperative Anticoagulation of Cardiovascular Implantable Electronic Devices Implantation in Patients Receiving Long-term Anticoagulant Therapy

大量需要植入心脏植入装置的患者正在接受长期抗凝治疗,围手术期面临出血和血栓栓塞事件的双重风险,多数指南推荐根据患者血栓栓塞危险度决定抗凝方案。围手术期进行肝素桥接或双联抗血小板治疗可显著增加囊袋血肿发生的风险,而不间断华法林可能是平衡利弊的优秀策略。现对长期抗凝者心脏植入型电子装置植入围手术期抗凝策略的现状和进展进行综述。

A large proportion of patients who require cardiovascular implantable electronic devices（CIED） implantation surgery are receiving long-term anticoagulant therapy, undertaking risks of both hemorrhagic and thromboembolic events during perioperative period. Most guidelines recommend altering anticoagulant regimens according to thromboembolism risks. The use of perioperative heparin bridging or dual antiplatelet therapy significantly increases the risk of pocket-hematoma. Warfarin continuation appears promising in terms of balancing the pros and cons. This article aims at reviewing the current status and potential development of CIED perioperative management of anticoag-ulant therapy.