Koh Youlin, Bingham Nicholas E, Law Natalie, Le Dustin, Mariani Justin A
Department of Cardiology, The Alfred Hospital, Prahran, Victoria, Australia.
Monash University, Clayton, Victoria, Australia.
Pacing Clin Electrophysiol. 2017 Jul;40(7):857-867. doi: 10.1111/pace.13106. Epub 2017 Jun 14.
Cardiac implantable electronic device (CIED) hematomas are associated with many adverse outcomes. We examined the incidence and risk factors associated with hematoma formation post-CIED implantation, and explored the preventative effect of prophylactic pressure bandaging (PPB) in a large tertiary center.
1,091 devices were implanted during October 2011-December 2014. Clinically significant hematomas (CSH) were those that necessitated prolonged admission, including those due to reoperation, and clinically suspicious hematomas were swellings noted by medical/nursing staff. We screened for variables affecting hematoma incidence prior to conducting multivariate logistic regression analyses, one for all hematomas and one for CSH.
61 hematomas were identified (5.6% of patients), with 12 of those clinically significant (1.1% of patients). Factors significantly increasing the odds of developing any hematoma were stage 2 (odds ratio [OR] = 2.93, 95% confidence interval [CI] [1.08-7.94], P = 0.034) and 3 chronic kidney disease (CKD) (OR = 3.39 [1.20-9.56], P = 0.021), unfractionated heparin/therapeutic enoxaparin (OR = 3.15 [1.22-8.14], P = 0.018), and dual antiplatelets-aspirin + clopidogrel (OR = 2.95 [1.14-7.65], P = 0.026) + other combinations. Body Mass index (BMI) 25.0-29.9 (OR 0.52 [0.28-0.98], P = 0.044) and >30 were associated with decreased hematoma risk (OR 0.43 [0.20-0.91], P = 0.028). Factors significant for CSH formation were unfractionated heparin/therapeutic enoxaparin (OR = 9.55 [1.83-49.84], P = 0.007) and aspirin + clopidogrel (OR = 7.19 [1.01-50.91], P = 0.048). PPB nonsignificantly increased the odds of total hematoma development (OR = 1.53 [0.87-2.69], P = 0.135), and reduced CSH (OR = 0.67 [0.18-2.47], P = 0.547).
Heparin and dual antiplatelet use remain strong predictors of overall hematoma formation. CKD is a comparatively moderate predictor. BMI > 25 may decrease the risk of hematoma formation. PPB had nonsignificant effects on hematoma development.
心脏植入式电子设备（CIED）血肿与许多不良后果相关。我们在一家大型三级中心研究了CIED植入术后血肿形成的发生率及相关危险因素，并探讨了预防性加压包扎（PPB）的预防效果。
2011年10月至2014年12月期间植入了1091台设备。具有临床意义的血肿（CSH）是指那些需要延长住院时间的血肿，包括因再次手术导致的血肿，临床可疑血肿是指医护人员注意到的肿胀。在进行多因素逻辑回归分析之前，我们筛选了影响血肿发生率的变量，一个针对所有血肿，另一个针对CSH。
共识别出61例血肿（占患者的5.6%），其中12例具有临床意义（占患者的1.1%）。显著增加发生任何血肿几率的因素包括2期（比值比[OR]=2.93，95%置信区间[CI][1.08 - 7.94]，P = 0.034）和3期慢性肾脏病（CKD）（OR = 3.39[1.20 - 9.56]，P = 0.021）、普通肝素/治疗剂量依诺肝素（OR = 3.15[1.22 - 8.14]，P = 0.018）以及双联抗血小板药物 - 阿司匹林 + 氯吡格雷（OR = 2.95[1.14 - 7.65]，P = 0.026）+其他组合。体重指数（BMI）25.0 - 29.9（OR 0.52[0.28 - 0.98]，P = 0.044）和>30与血肿风险降低相关（OR 0.43[0.20 - 0.91]，P = 0.028）。对CSH形成有显著意义的因素是普通肝素/治疗剂量依诺肝素（OR = 9.55[1.83 - 49.84]，P = 0.007）和阿司匹林 + 氯吡格雷（OR = 7.19[1.01 - 50.91]，P = 0.048）。PPB使总血肿发生几率非显著增加（OR = 1.53[0.87 - 2.69]，P = 0.135），并降低了CSH（OR = 0.67[0.18 - 2.47]，P = 0.547）。
肝素和双联抗血小板药物的使用仍然是总体血肿形成的强预测因素。CKD是一个相对中等的预测因素。BMI>25可能会降低血肿形成的风险。PPB对血肿发生没有显著影响。
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