起搏器围手术期不同抗凝方案安全性评价

Safety of different anticoagulant methods in perioperative period of pacemaker implantation

目的比较起搏器围手术期不同抗凝方案的安全性。方法回顾性分析医院收治的长期服用抗凝药物并需要安装永久起搏器的86例患者的临床资料,根据抗凝方案的不同将其分为A、B、C 3组。A组28例,围手术期不中断使用华法林治疗;B组29例,起搏器术前3~5 d停用华法林,之后不进行抗凝,术后12 h恢复使用华法林;C组29例,起搏器术前3~5 d停用华法林,以低分子肝素钠桥接治疗,术后12 h恢复使用华法林。比较3组住院时间、囊袋相关并发症及血栓栓塞事件发生情况。结果 A组住院时间最短,C组最长,3组间比较有显著差异(P<0.05)。总囊袋相关并发症发生率A组为3.57%、B组为6.90%、C组为17.24%,A组的发生率最低,而C组最高,但3组间囊袋相关并发症发生率和血栓栓塞事件发生率差异均不显著(P>0.05)。结论起搏器围手术期不中断使用华法林为理想的抗凝方案,总囊袋相关并发症发生率相对较低。

Objective To compare the safety of different anticoagulant methods in the perioperative period of pacemaker implantation.Methods The clinical data of a total of 86 patients who had been admitted to our hospital and had taken anticoagulants for a long time to install a permanent pacemaker were analyzed retrospectively. The patients were divided into groups A, B and C according to different anticoagulant methods. Warfarin therapy was adopted in Group A （n =28） in the perioperative period without interruption; warfarin therapy in group B（n=29） was stopped 3-5 days before pacemaker implantation, after which no anticoagulation was conducted, and resumed 12 hours after the operation; warfarin therapy in group C （n=29） was stopped 3-5 days before pacemaker implantation, after which bridging therapy with low molecular weight heparin （LMWH） was conducted, and resumed 12 hours after the operation. The length of stay （LOS）, and incidence of complications associated with sac and thromboembolic events among the three groups were compared. Results The LOS was the shortest in group A and the longest in group C, showing significant difference among the three groups （P 〈 0.05）. The total incidence of complications associated with sac was 3.57% in group A, 6.90% in group B and 17.24% in group C. The incidence in group A was the lowest and that in group C was the highest, but the difference in the complications associated with sac and thromboembolic events among the three groups showed no significant difference （P 〉 0.05）. Conclusion The uninterrupted use of warfarin in perioperative period of pacemaker implantation is an ideal anticoagulation method. The total incidence of complications associated with sac in relatively low.