经静脉导线拔除并发症中抗栓治疗的临床影响：ESC-EORP EHRA ELECTRa（欧洲导线拔除对照）注册研究的亚分析。

Clinical impact of antithrombotic therapy in transvenous lead extraction complications: a sub-analysis from the ESC-EORP EHRA ELECTRa (European Lead Extraction ConTRolled) Registry.

机构信息

Second Division of Cardiology, Department of Cardiac-Thoracic & Vascular, Azienda Ospedaliera Pisana, Via Paradisa 2, Pisa, Italy.

Fondazione Cardiocentro Ticino, Via Tesserete 48, Lugano, Italy.

出版信息

Europace. 2019 Jul 1;21(7):1096-1105. doi: 10.1093/europace/euz062.

DOI:10.1093/europace/euz062

PMID:31505593

Abstract

AIMS

A sub-analysis of the ESC-EHRA European Lead Extraction ConTRolled (ELECTRa) Registry to evaluate the clinical impact of antithrombotic (AT) on transvenous lead extraction (TLE) safety and efficacy.

METHODS AND RESULTS

ELECTRa outcomes were compared between patients without AT therapy (No AT Group) and with different pre-operative AT regimens, including antiplatelets (AP), anticoagulants (AC), or both (AP + AC). Out of 3510 pts, 2398 (68%) were under AT pre-operatively. AT patients were older with more comorbidities (P < 0.0001). AT subgroups, defined as AP, AC, or AP + AC, were 1096 (31.2%), 985 (28%), and 317 (9%), respectively. Regarding AP patients, 1413 (40%) were under AP, 1292 (91%) with a single AP, interrupted in 26% about 3.8 ± 3.7 days before TLE. In total, 1302 (37%) patients were under AC, 881 vitamin K antagonist (68%), 221 (17%) direct oral anticoagulants, 155 (12%) low weight molecular heparin, and 45 (3.5%) unfractionated heparin. AC was 'interrupted without bridging' in 696 (54%) and 'interrupted with bridging' in 504 (39%) about 3.3 ± 2.3 days before TLE, and 'continued' in 87 (7%). TLE success rate was high in all subgroups. Only overall in-hospital death (1.4%), but not the procedure-related one, was higher in the AT subgroups (P = 0.0500). Age >65 years and New York Heart Association Class III/IV, but not AT regimens, were independent predictors of death for any cause. Haematomas were more frequent in AT subgroups, especially in AC 'continued' (P = 0.025), whereas pulmonary embolism in the No-AT (P < 0.01).

CONCLUSIONS

AT minimization is safe in patients undergoing TLE. AT does not seem to predict death but identifies a subset of fragile patients with a worse in-hospital TLE outcome.

摘要

目的

对 ESC-EHRA 欧洲经皮心内导线拔除控制（ELECTRa）登记处的一项亚组分析，以评估抗血栓（AT）治疗对经静脉心内导线拔除（TLE）安全性和疗效的临床影响。

方法和结果

比较了无 AT 治疗（无 AT 组）和不同术前 AT 方案（包括抗血小板治疗[AP]、抗凝治疗[AC]或两者联合[AP+AC]）患者的 ELECTRa 结果。在 3510 例患者中，2398 例（68%）术前接受 AT 治疗。AT 患者年龄较大，合并症更多（P<0.0001）。AT 亚组定义为 AP、AC 或 AP+AC，分别为 1096 例（31.2%）、985 例（28%）和 317 例（9%）。AP 患者中，1413 例（40%）接受 AP 治疗，1292 例（91%）接受单一 AP 治疗，其中 26%的患者约在 TLE 前 3.8±3.7 天中断治疗。共有 1302 例（37%）患者接受 AC 治疗，881 例（68%）为维生素 K 拮抗剂，221 例（17%）为直接口服抗凝剂，155 例（12%）为低分子量肝素，45 例（3.5%）为未分级肝素。696 例（54%）患者在 TLE 前约 3.3±2.3 天「无桥接中断」，504 例（39%）「有桥接中断」，87 例（7%）「继续」。所有亚组的 TLE 成功率均较高。仅总体住院死亡率（1.4%），而非与操作相关的死亡率，在 AT 亚组中更高（P=0.0500）。年龄>65 岁和纽约心脏协会心功能分级 III/IV 级，但不是 AT 方案，是任何原因导致死亡的独立预测因素。在 AT 亚组中血肿更常见，尤其是在「继续」的 AC 亚组（P=0.025），而在无 AT 组中则更常见肺栓塞（P<0.01）。