Electrophysiology Section, Cardiology Department, Hospital Universitario La Fe, C/ Lope de Rueda, 48, 3, 46001 Valencia, Spain.
Europace. 2011 Mar;13(3):395-401. doi: 10.1093/europace/euq431. Epub 2010 Dec 4.
Perioperative management of antiplatelet (AP) therapy in patients undergoing implantation of cardiac rhythm management devices (CRMD) remains an issue of concern that has not been prospectively evaluated in a large series. We sought to describe the morbidity associated with three different AP regimens in this setting.
We conducted a prospective observational study including 849 consecutive patients who were classified in three groups according to the presence of any AP treatment: Group 1 (n= 220): single AP therapy; Group 2 (n= 60): dual AP therapy; and Group 3 (n= 40): oral anticoagulant (OAC) + enoxaparin 'bridging' + AP therapy. Two other groups served as controls: Group 4 (n= 375): no AP or OAC therapy; and Group 5 (n= 154): OAC + enoxaparin 'bridging'. The incidence of pocket haematoma, pocket revisions, hospital stays duration, and unscheduled follow-up visits due to pocket-related complications were compared. Patients on Groups 2, 3 and 5 had significantly higher incidences of pocket haematoma (13.3, 15, and 14.9%, respectively) when compared with Groups 1 and 4 (3.2 and 2.4%, respectively), as well as longer hospital stays and more unscheduled follow-up visits. Of note, only patients on enoxaparin 'bridging' required surgical revision of the pocket. Dual AP therapy (P< 0.001), enoxaparin 'bridging' (P< 0.001) and renal insufficiency (P= 0.02) were independent predictors of pocket haematoma in multivariate analysis.
Dual AP therapy and OAC + AP therapy is strongly associated with a significant risk of pocket haematoma, longer hospital stays, and unscheduled follow-up visits. Importantly, surgical revision of the pocket was associated with enoxaparin 'bridging' strategy but was never necessary in patients taking exclusively antiaggregant agents.
在植入心脏节律管理装置（CRMD）的患者中，抗血小板（AP）治疗的围手术期管理仍然是一个令人关注的问题，尚未在大型系列中进行前瞻性评估。我们旨在描述在这种情况下三种不同 AP 方案相关的发病率。
我们进行了一项前瞻性观察研究，纳入了 849 例连续患者，根据是否存在任何 AP 治疗将患者分为三组：组 1（n=220）：单一 AP 治疗；组 2（n=60）：双重 AP 治疗；和组 3（n=40）：口服抗凝剂（OAC）+依诺肝素“桥接”+AP 治疗。另外两组作为对照组：组 4（n=375）：无 AP 或 OAC 治疗；和组 5（n=154）：OAC+依诺肝素“桥接”。比较了口袋血肿、口袋修订、住院时间以及因口袋相关并发症而进行的非计划随访次数。与组 1 和组 4（分别为 3.2%和 2.4%）相比，组 2、组 3 和组 5 的口袋血肿发生率（分别为 13.3%、15%和 14.9%）显著更高，住院时间更长，非计划随访次数更多。值得注意的是，只有接受依诺肝素“桥接”的患者需要进行口袋手术修订。多变量分析显示，双重 AP 治疗（P<0.001）、依诺肝素“桥接”（P<0.001）和肾功能不全（P=0.02）是口袋血肿的独立预测因素。
双重 AP 治疗和 OAC+AP 治疗与口袋血肿、较长的住院时间和非计划随访显著相关。重要的是，口袋的手术修订与依诺肝素“桥接”策略有关，但在仅接受抗聚集剂的患者中从未有必要。
