Division of Cardiology, Department of Internal Medicine, University of Ulsan College of Medicine, Gangneung Asan Hospital, Gangneung, Korea.
Korean Circ J. 2012 Aug;42(8):538-42. doi: 10.4070/kcj.2012.42.8.538. Epub 2012 Aug 31.
The growing implantations of electrophysiological devices in the context of increasing rates of chronic antithrombotic therapy in cardiovascular disease patients underscore the importance of an effective periprocedural prophylactic strategy for prevention of bleeding complications. We assessed the risk of significant bleeding complications in patients receiving anti-platelet agents or anticoagulants at the time of permanent pacemaker (PPM) implantation.
We reviewed bleeding complications in patients undergoing PPM implantation. The use of aspirin or clopidogrel was defined as having taking drugs within 5 days of the procedure and warfarin was changed to heparin before the procedure. A significant bleeding complication was defined as a bleeding incident requiring pocket exploration or blood transfusion.
Permanent pacemaker implantations were performed in 164 men and 96 women. The mean patient age was 73±11 years old. Among the 260 patients, 14 patients took warfarin (in all of them, warfarin was changed to heparin at least 3 days before procedure), 54 patients took aspirin, 4 patients took clopidogrel, and 25 patients took both. Significant bleeding complications occurred in 8 patients (3.1%), all of them were patients with heparin bridging (p<0.0001). Heparin bridging markedly increased the length of required hospital stay when compare with other groups and the 4 patients (1.5%) that underwent the pocket revision for treatment of hematoma.
This study suggests that hematoma formation after PPM implantation was rare, even among those who had taken the anti-platelet agents. The significant bleeding complications frequently occurred in patients with heparin bridging therapy. Therefore, heparin bridging therapy was deemed as high risk for significant bleeding complication in PPM implantation.
心血管疾病患者中慢性抗血栓治疗率不断上升，在此背景下，电生理设备的植入量不断增加，这突显了在永久性心脏起搏器（PPM）植入术中采取有效预防出血并发症的围手术期预防策略的重要性。我们评估了在接受抗血小板或抗凝药物治疗的患者中，在进行 PPM 植入术时发生严重出血并发症的风险。
我们回顾了接受 PPM 植入术的患者的出血并发症情况。在距手术 5 天内使用阿司匹林或氯吡格雷定义为正在服用药物，在术前将华法林换为肝素。严重出血并发症定义为需要进行囊袋探查或输血的出血事件。
164 名男性和 96 名女性患者接受了 PPM 植入术。患者的平均年龄为 73±11 岁。在 260 名患者中，有 14 名患者服用华法林（在所有患者中，至少在术前 3 天将华法林换为肝素），54 名患者服用阿司匹林，4 名患者服用氯吡格雷，25 名患者同时服用两种药物。8 名患者（3.1%）发生了严重出血并发症，均为接受肝素桥接治疗的患者（p<0.0001）。与其他组相比，肝素桥接治疗显著增加了所需的住院时间，4 名（1.5%）因血肿而行囊袋翻修的患者也接受了这种治疗。
本研究表明，即使在服用抗血小板药物的患者中，PPM 植入术后血肿的形成也很少见。严重出血并发症常发生在接受肝素桥接治疗的患者中。因此，肝素桥接治疗被认为是 PPM 植入术发生严重出血并发症的高风险因素。
