Division of Cardiology, Centre of Internal Medicine, University Hospital Magdeburg, Otto-von-Guericke University, Leipziger Str. 44, 39120 Magdeburg, Germany.
Clin Res Cardiol. 2013 May;102(5):345-9. doi: 10.1007/s00392-013-0543-8. Epub 2013 Feb 6.
We retrospectively assessed the incidence of hemorrhagic complications associated with pacemaker implantation in patients receiving one or more antiplatelet agents.
Retrospective multicenter case-control study. Data were collected from three cardiac units in Germany from 2006 to 2010.
A total of 495 pacemaker patients were enrolled. 99 patients received dual antiplatelet therapy (aspirin and clopidogrel), 198 were given only aspirin and 198 had no antiplatelet therapy (control). Patients were matched for age and sex. Implant-related bleeding complications were defined as major bleeding, if surgical pocket exploration or blood transfusion were needed. Minor bleeding complications were defined as one or more of the following conditions: fall of hemoglobin content >1.5 g/dl not requiring blood transfusion; pocket hematoma; pocket effusion not requiring surgical revision.
Hemorrhagic complications were seen in 4/198 control patients and 6/198 aspirin-only patients [2 vs. 3 %, p = 0.5, OR = 1.52 (0.42-5.46)]. Patients undergoing dual antiplatelet therapy had significantly more bleeding complications than patients in the aspirin-only group [11/99: 11.1 vs. 3 %, p = 0.005, OR = 3.95 (1.43-11.16)]. Major complications occurred in 1/198 control patients and 2/198 aspirin-only patients [0.5 vs. 1 %, p = 0.6, OR = 2.01 (0.18-22.35)]. In contrast, 7/99 patients undergoing dual antiplatelet therapy exhibited major complications [7.1 vs. 1 %, p = 0.004, OR = 7.46 (1.52-36.50)].
Although in patients undergoing pacemaker implantation dual antiplatelet therapy with aspirin and clopidogrel caused a significant increase of bleeding complications, the use of aspirin alone was not associated with a significant increase in bleeding complications.
我们回顾性评估了在接受一种或多种抗血小板药物治疗的患者中，与起搏器植入相关的出血并发症的发生率。
回顾性多中心病例对照研究。数据来自德国三个心脏单位，时间跨度为 2006 年至 2010 年。
共纳入 495 例起搏器患者。99 例患者接受双联抗血小板治疗（阿司匹林和氯吡格雷），198 例仅接受阿司匹林治疗，198 例未接受抗血小板治疗（对照组）。患者按年龄和性别匹配。与器械相关的出血并发症定义为主要出血，如果需要手术探查或输血。次要出血并发症定义为以下一种或多种情况：血红蛋白含量下降>1.5 g/dl 但无需输血；囊袋血肿；无需手术修正的囊袋积液。
对照组有 4/198 例和阿司匹林组有 6/198 例（2% vs. 3%，p=0.5，OR=1.52（0.42-5.46））出现出血并发症。接受双联抗血小板治疗的患者出血并发症明显多于仅接受阿司匹林治疗的患者[11/99：11.1% vs. 3%，p=0.005，OR=3.95（1.43-11.16）]。对照组有 1/198 例和阿司匹林组有 2/198 例发生严重并发症（0.5% vs. 1%，p=0.6，OR=2.01（0.18-22.35））。相比之下，双联抗血小板治疗组有 7/99 例发生严重并发症[7.1% vs. 1%，p=0.004，OR=7.46（1.52-36.50）]。
尽管在接受起搏器植入的患者中，阿司匹林双联抗血小板治疗显著增加了出血并发症的发生，但单独使用阿司匹林并未显著增加出血并发症的发生。
