Melton Brittany L, Howard Patricia A, Goerdt Abby, Casey Jessica
Assistant Professor, Department of Pharmacy Practice, University of Kansas School of Pharmacy , Lawrence, Kansas.
Professor and Vice Chair, Department of Pharmacy Practice, University of Kansas Medical Center , Kansas City, Kansas.
Hosp Pharm. 2015 Oct;50(9):761-6. doi: 10.1310/hpj5009-761. Epub 2015 Oct 14.
Implantation of permanent pacemakers (PPMs) or implantable cardiac defibrillators (ICDs) may be complicated by the development of pocket hematomas. Current practice guidelines provide little guidance to clinicians about the preferred strategy for chronic oral anticoagulation (OAC). The purpose of this study was to examine the frequency and clinical significance of pocket hematoma among patients receiving uninterrupted OAC during cardiac device implantation.
This was a retrospective cohort study of adult patients undergoing cardiac device implantation between January 1, 2011, and December 31, 2012, at an academic teaching hospital. Medical records were reviewed for demographics, comorbidities, and medications. The primary outcome was development of pocket hematomas within 30 days of device implantation. Clinical significance was based on the need for additional intervention. Data were assessed using descriptive statistics, logistic regression, and chi-square tests.
The final cohort included 380 patients. The median age was 68.4 years, and 56.6% were male. Cardiovascular comorbidities were common. Among 80 patients receiving uninterrupted OAC, 71.3% were taking warfarin, 11.2% rivaroxaban, and 17.5% dabigatran. The incidence of pocket hematomas for the entire cohort was 9.7%, of which 1.3% were clinically significant. Pocket hematoma occurred in 21.4% of patients continued on OAC versus 7.7% of those not anticoagulated (P = .001). Pocket hematoma was more common among those receiving ICDs than PPMs (18.5% vs 5.7%, respectively; P < .001).
Continuing chronic OAC increased pocket hematoma formation but most were clinically insignificant. Pocket hematoma occurred irrespective of the oral anticoagulant drug used, but additional study is needed to determine comparative risks among the drugs.
永久性起搏器（PPM）或植入式心脏除颤器（ICD）植入可能会因囊袋血肿的形成而变得复杂。目前的实践指南几乎没有为临床医生提供关于慢性口服抗凝治疗（OAC）首选策略的指导。本研究的目的是检查在心脏设备植入期间接受不间断OAC治疗的患者中囊袋血肿的发生率及临床意义。
这是一项对2011年1月1日至2012年12月31日在一家学术教学医院接受心脏设备植入的成年患者进行的回顾性队列研究。对病历进行人口统计学、合并症和用药情况的审查。主要结局是设备植入后30天内囊袋血肿的形成。临床意义基于是否需要额外干预。使用描述性统计、逻辑回归和卡方检验对数据进行评估。
最终队列包括380名患者。中位年龄为68.4岁，56.6%为男性。心血管合并症很常见。在80名接受不间断OAC治疗的患者中，71.3%服用华法林，11.2%服用利伐沙班，17.5%服用达比加群。整个队列中囊袋血肿的发生率为9.7%，其中1.3%具有临床意义。继续接受OAC治疗的患者中有21.4%发生囊袋血肿，而未接受抗凝治疗的患者中这一比例为7.7%（P = 0.001）。接受ICD的患者比接受PPM的患者更易发生囊袋血肿（分别为18.5%和5.7%；P < 0.001）。
继续进行慢性OAC治疗会增加囊袋血肿的形成，但大多数在临床上无显著意义。无论使用何种口服抗凝药物都会发生囊袋血肿，但需要进一步研究以确定不同药物之间的相对风险。
