Department of Cardiology, University Hospital La Timone, Marseilles, France
Department of Cardiology, Institution of Medical Science, Uppsala University, Uppsala, Sweden.
Europace. 2016 May;18(5):778-84. doi: 10.1093/europace/euw127.
The European Snapshot Survey on Procedural Routines for Electronic Device Implantation (ESS-PREDI) was a prospective European survey of consecutive adults who had undergone implantation/surgical revision of a cardiac implantable electronic device (CIED) on chronic antithrombotic therapy (enrolment March-June 2015). The aim of the survey was to investigate perioperative treatment with oral anticoagulants and antiplatelets in CIED implantation or surgical revision and to determine the incidence of complications, including clinically significant pocket haematomas. Information on antithrombotic therapy before and after surgery and bleeding and thromboembolic complications occurring after the intervention was collected at first follow-up. The study population comprised 723 patients (66.7% men, 76.9% aged ≥66 years). Antithrombotic treatment was continued during surgery in 489 (67.6%) patients; 6 (0.8%) had their treatment definitively stopped; 46 (6.4%) were switched to another antithrombotic therapy. Heparin bridging was used in 55 out of 154 (35.8%) patients when interrupting vitamin K antagonist (VKA) treatment. Non-vitamin K oral anticoagulant (NOAC) treatment was interrupted in 88.7% of patients, with heparin bridging in 25.6%, but accounted for only 25.3% of the oral anticoagulants used. A total of 108 complications were observed in 98 patients. No intracranial haemorrhage or embolic events were observed. Chronic NOAC treatment before surgery was associated with lower rates of minor pocket haematoma (1.4%; P= 0.042) vs. dual antiplatelet therapy (13.0%), VKA (11.4%), VKA + antiplatelet (9.2%), or NOAC + antiplatelet (7.7%). Similar results were observed for bleeding complications (P= 0.028). Perioperative management of patients undergoing CIED implantation/surgical revision while on chronic antithrombotic therapy varies, with evidence of a disparity between guideline recommendations and practice patterns in Europe. Haemorrhagic complications were significantly less frequent in patients treated with NOACs. Despite this, the incidence of severe pocket haematomas was low.
欧洲电子设备植入程序常规调查（ESS-PREDI）是一项针对连续接受心脏植入式电子设备（CIED）植入/手术修复并接受慢性抗血栓治疗的成年人的前瞻性欧洲调查（2015 年 3 月至 6 月招募）。该调查的目的是研究 CIED 植入或手术修复期间口服抗凝剂和抗血小板药物的围手术期治疗，并确定包括临床显著的囊袋血肿在内的并发症发生率。在首次随访时收集了手术前后抗血栓治疗以及介入后发生的出血和血栓栓塞并发症的信息。研究人群包括 723 名患者（66.7%为男性，76.9%年龄≥66 岁）。489 名（67.6%）患者在手术期间继续进行抗血栓治疗；6 名（0.8%）患者的治疗被明确停止；46 名（6.4%）患者转为另一种抗血栓治疗。在 154 名中断维生素 K 拮抗剂（VKA）治疗的患者中，有 55 名（35.8%）使用肝素桥接。88.7%的非维生素 K 口服抗凝剂（NOAC）治疗患者中断治疗，其中 25.6%使用肝素桥接，但仅占使用的口服抗凝剂的 25.3%。98 名患者共观察到 108 例并发症。未观察到颅内出血或栓塞事件。与双重抗血小板治疗（13.0%）、VKA（11.4%）、VKA+抗血小板治疗（9.2%）或 NOAC+抗血小板治疗（7.7%）相比，手术前接受慢性 NOAC 治疗的患者，小囊袋血肿（1.4%；P=0.042）和出血并发症（P=0.028）的发生率较低。对于接受心脏植入式电子设备（CIED）植入/手术修复的患者，在接受慢性抗血栓治疗时，围手术期管理各不相同，这表明欧洲的指南建议与实践模式之间存在差异。接受 NOAC 治疗的患者出血并发症明显较少。尽管如此，严重囊袋血肿的发生率仍然很低。
