Ishibashi Kohei, Miyamoto Koji, Kamakura Tsukasa, Wada Mitsuru, Nakajima Ikutaro, Inoue Yuko, Okamura Hideo, Noda Takashi, Aiba Takeshi, Kamakura Shiro, Shimizu Wataru, Yasuda Satoshi, Akasaka Takashi, Kusano Kengo
Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, 565-8565, Japan.
Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.
Heart Vessels. 2017 Mar;32(3):333-340. doi: 10.1007/s00380-016-0879-x. Epub 2016 Jul 28.
Previous studies showed that continuous anticoagulation or single antiplatelet therapy during implantations of cardiac implantable electronic devices (CIED) was relatively safe. However, the safety of continuous multi antithrombotic therapy (AT) in patients undergoing CIED interventions has not been clearly defined. We sought to evaluate the safety of this therapy during CIED implantations. A total of 300 consecutive patients (mean 69 years old, 171 males) with CIED implantations were enrolled in this study. The patients were divided into 6 groups [No-AT, oral anticoagulant therapy (OAT), single antiplatelet therapy (SAPT), OAT and SAPT, dual antiplatelet therapy (DAPT), triple AT (TAT)], and the perioperative complications were evaluated. Clinically significant pocket hematomas (PH) were defined as PH needing surgical intervention, prolonged hospitalizations, interruption of AT, or blood product transfusions. There were 129, 89, 49, 20, 10, and 3 patients in No-AT, OAT, SAPT, OAT + SAPT, DAPT, and TAT groups, respectively. The occurrence of clinically significant PH and thromboembolism did not differ among 6 groups (p = 0.145 and p = 0.795, respectively). However, high HAS-BLED score and valvular heart disease (VHD) were associated with clinically significant PH (p = 0.014 and p = 0.015, respectively). Continuous multi AT may be tolerated, but patients with high HAS-BLED score or VHD would require a careful attention during CIED implantations.
先前的研究表明，在植入心脏植入式电子设备（CIED）期间进行持续抗凝或单一抗血小板治疗相对安全。然而，CIED干预患者中持续多抗栓治疗（AT）的安全性尚未明确界定。我们试图评估该治疗在CIED植入期间的安全性。本研究共纳入300例连续接受CIED植入的患者（平均年龄69岁，男性171例）。患者被分为6组[无抗栓治疗组、口服抗凝治疗（OAT）组、单一抗血小板治疗（SAPT）组、OAT和SAPT组、双联抗血小板治疗（DAPT）组、三联抗栓治疗（TAT）组]，并评估围手术期并发症。具有临床意义的囊袋血肿（PH）定义为需要手术干预、延长住院时间、中断抗栓治疗或输血的PH。无抗栓治疗组、OAT组、SAPT组、OAT + SAPT组、DAPT组和TAT组分别有129例、89例、49例、20例、10例和3例患者。6组之间具有临床意义的PH和血栓栓塞的发生率无差异（分别为p = 0.145和p = 0.795）。然而，高HAS - BLED评分和瓣膜性心脏病（VHD）与具有临床意义的PH相关（分别为p = 0.014和p = 0.015）。持续多抗栓治疗可能是可耐受的，但CIED植入期间，HAS - BLED评分高或患有VHD的患者需要密切关注。
