Pecha Simon, Ayikli Ayhan, Wilke Iris, Hakmi Samer, Yildirim Yalin, Gosau Nils, Reichenspurner Hermann, Willems Stephan, Aydin Muhammet Ali
Department of Cardiovascular Surgery, University Heart Center Hamburg, Martinistr. 52, 20246, Hamburg, Germany.
Department of Cardiology, Electrophysiology, University Heart Center Hamburg, Hamburg, Germany.
Heart Vessels. 2018 Apr;33(4):441-446. doi: 10.1007/s00380-017-1064-6. Epub 2017 Oct 13.
Recent studies have shown that subcutaneous or subfascial pacemaker- and ICD implantation with continued oral anticoagulation therapy is associated with lower risk for bleeding complications, when compared to heparin bridging strategies. However, ICD generators are often implanted submuscularly. We therefore compared the bleeding risk with continued phenprocoumon therapy vs. heparin bridging in patients receiving submuscular ICD implantation. Between 01/2013 and 12/2013, 104 patients with need for oral anticoagulation received submuscular ICD or CRT-D implantation in our institution. 46 patients were implanted under continued phenprocoumon therapy while 58 patients received heparin bridging for implantation procedure. All ICD generators were placed submuscularly. The primary outcome of the study was clinically significant bleeding or device pocket hematoma with need for surgical revision. Mean patients age was 63.7 years, 72.1% were male. In patients with heparin bridging therapy, preoperative INR prior to ICD implantation was 1.2 ± 0.31 while in the group of patients on continued phenprocoumon therapy, mean pre-OP INR was 2.4 ± 0.47. In heparin bridging group, 8 (13.8%) patients experienced a clinically relevant pocket hematoma, while only 1 (2.2%) patient on continued phenprocoumon therapy needed surgical revision for pocket hematoma (P = 0.04). No further bleeding complications or clinically relevant pericardial effusion was observed in any of the groups and no perioperative thromboembolic event occurred. Submuscular ICD implantation under continued phenprocoumon therapy was safe and feasible. Compared to patients with heparin bridging therapy, those with continued phenprocoumon therapy had a lower incidence of clinically relevant bleeding complications.
近期研究表明，与肝素桥接策略相比，皮下或筋膜下植入起搏器和植入式心脏除颤器（ICD）并继续口服抗凝治疗，出血并发症风险更低。然而，ICD发生器常植入肌肉下。因此，我们比较了在接受肌肉下ICD植入的患者中，继续使用苯丙香豆素治疗与肝素桥接的出血风险。在2013年1月至2013年12月期间，104例需要口服抗凝治疗的患者在我们机构接受了肌肉下ICD或心脏再同步化治疗除颤器（CRT-D）植入。46例患者在继续苯丙香豆素治疗的情况下植入，而58例患者在植入过程中接受肝素桥接。所有ICD发生器均放置在肌肉下。该研究的主要结局是具有临床意义的出血或需要手术翻修的设备囊袋血肿。患者平均年龄为63.7岁，72.1%为男性。在接受肝素桥接治疗的患者中，ICD植入术前的国际标准化比值（INR）为1.2±0.31，而在继续苯丙香豆素治疗的患者组中，术前平均INR为2.4±0.47。在肝素桥接组中，8例（13.8%）患者出现了具有临床意义的囊袋血肿，而在继续苯丙香豆素治疗的患者中，只有1例（2.2%）因囊袋血肿需要手术翻修（P=0.04）。在任何一组中均未观察到进一步的出血并发症或具有临床意义的心包积液，也未发生围手术期血栓栓塞事件。在继续苯丙香豆素治疗的情况下进行肌肉下ICD植入是安全可行的。与接受肝素桥接治疗的患者相比，继续苯丙香豆素治疗的患者具有临床意义的出血并发症发生率更低。
